More than half of institutions (53.7%) did not have ventilator triage policies when COVID-19 hit, according to the authors of a study.1

“We were surprised, given the work that had been done on ventilator triage during the H1N1 influenza pandemic,” says Armand H. Matheny Antommaria, MD, PhD, FAAP, director of the Ethics Center at Cincinnati Children’s Hospital.

As the pandemic spread, people expected the demand for ventilators would be much greater than the supply. “There were media reports that ventilators were being triaged in Italy. Hospitals in Seattle and New York were experiencing growing clinical demands,” Antommaria says.

Members of the Association of Bioethics Program Directors had access to existing policies at their own and affiliated institutions. The ethicists also had the right expertise to analyze the policies.

“To the extent that there was a clear consensus about triage criteria, we thought that identifying it would be beneficial to our colleagues and policymakers,” Antommaria says.

Allocation criteria was surprisingly varied. Almost all (96%) policies used benefit, but only 54% used need (50% used age). “Two similar individuals in a community might be treated differently depending on which hospital they went to for care,” Antommaria says.

This was ethically concerning. “The omission of key ethical norms was also notable,” Antommaria adds.

For example, only half of all policies required or recommended that individuals making triage decisions not be involved in direct patient care. The researchers expected almost all policies to include this.

“One of the main ethical implications is that there is still substantial work for us to do to fulfill our duty to plan,” Antommaria says. “Ethicists should be involved in these planning processes.”


  1. Matheny Antommaria AH, Gibb TS, McGuire AL, et al. Ventilator triage policies during the COVID-19 pandemic at U.S. hospitals associated with members of the Association of Bioethics Program Directors. Ann Intern Med 2020;M20-1738. doi: 10.7326/M20-1738. [Online ahead of print].