Philosophers Help Swedish Government Develop Healthcare Prioritization and Rationing Policies


The National Board of Health and Welfare, one of Sweden’s main agencies for handling the COVID-19 pandemic, brought in philosophers in to help them design new guidelines for priority-setting in medical care and the rationing of healthcare resources.

The work was led by philosopher Lars Sandman, director of the Centre for Healthcare Priority Setting and a professor of healthcare ethics at Linköping University. The other philosophers and medical ethicists involved in the project were Erik Gustavsson (Linköping),  Mats Johansson (Lund), Niklas Juth (Karolinska), Ulrik Kihlbom (Uppsala), Erik Malmqvist (Gothenburg), and Christian Munthe (Gothenburg).

[center: Lars Sandman. clockwise from left: Erik Gustavsson, Mats Johansson, Niklas Juth, Ulrik Kihlbom, Erik Malmqvist, Christian Munthe]

Their proposals are based on the Swedish ethics platform for priority setting in healthcare and are intended to be incorporated into the existing national guidelines for use under the current extreme conditions.

Dr. Sandman says that the main focus of the work was how to prioritize among intensive care patients and how to ration other parts of the healthcare system so as to free up resources for use where they are most needed. For example:

In Sweden we are not allowed to take chronological age into account, but biological age—so the main thrust of the guidelines are how to interpret biological age in this situation—and we interpret it as covering both probability to survive the treatment and life-expectancy in terms of years. Hence, we propose that if doctors and other healthcare providers have to choose between helping patients with the same probability to survive but different life-expectancies, they should choose to help the patient with more years left. In relation to the ethical principles in the platform this is a somewhat new interpretation or clarification that has never been explicitly done before.

The new guidelines are not yet available online.

Meanwhile, one of the philosophers on the project, Christian Munthe, has been “rapidly recruited to assist with ethical expertise in a brand new EU-funded project at the Karolinska Institutet that aims to develop treatments for Covid-19 based on immunotherapy,” according to a press release.

 

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