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Frailty as a Priority-Setting Criterion for Potentially Lifesaving Treatment—Self-Fulfilling Prophecy, Circularity, and Indirect Discrimination?

Published online by Cambridge University Press:  24 November 2022

Søren Holm  and
Daniel Joseph Warrington
Søren Holm*
Affiliation:
Centre for Medical Ethics, HELSAM, Faculty of Medicine, University of Oslo, Oslo, Norway Centre for Social Ethics and Policy, Department of Law, School of Social Sciences, University of Manchester, Manchester M13 9PL, UK
Daniel Joseph Warrington
Affiliation:
Centre for Social Ethics and Policy, Department of Law, School of Social Sciences, University of Manchester, Manchester M13 9PL, UK
*
*Corresponding author. Email: soren.holm@medisin.uio.no
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Abstract

Frailty is a state of increased vulnerability to poor resolution of homeostasis after a stressor event. Frailty is most frequently assessed in the old using the Clinical Frailty Scale (CSF) which ranks frailty from 1 to 9. This assessment typically takes less than one minute and is not validated in patients with learning difficulties or those under 65 years old. The National Institute for Health and Care Excellence (NICE) developed guidelines that use “frailty” as one of the priority-setting criteria for how scarce, but potentially lifesaving, health care resources should be allocated during the COVID-19 pandemic. Similar guidelines have been developed elsewhere. This paper discusses the ethical implications of such rationing and argues that this is an unproven and ethically problematic form of health care rationing. It specifically discusses: (1) how the frailty ascription becomes a self-fulfilling prophecy, (2) the problematic use of “frailty” in COVID-19 “triage,” (3) the circularity of the link between age and frailty, (4) indirect discrimination because of the use of a seemingly neutral criterion in health care rationing, and (5) the difficult link between comorbidities and frailty. It is found that there was no research into the use of global frailty scores as a criterion for access to acute treatment before January 2020 and so it is concerning how readily frailty scoring has been adopted to ration access to potentially lifesaving treatments. Existing gerontological frailty scoring systems have not been developed for this purpose, and repurposing them creates significant ethical issues.

Keywords

COVID-19discriminationfrailtypriority settingrationing
Type
Research Article
Information
Cambridge Quarterly of Healthcare Ethics , Volume 32 , Issue 1 , January 2023 , pp. 48 - 55
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

Notes

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