Coronavirus: ACP, AMA say pandemic brings inequities into focus

In a joint letter from the leadership of both organizations, the American College of Physicians (ACP) and the American Medical Association (AMA) are calling for the U.S. healthcare system to wake up to the inequities laid bare by the COVID-19 coronavirus pandemic.

The June 16 letter, from ACP President Jacqueline W. Fincher, MD, and former AMA President Patrice A. Harris, MD, says that the pandemic has brought into focus the inequities in the system and that after the pandemic has passed things cannot go back to business as usual.

“The public health crisis of a pandemic challenges medicine's ethical duty to place the care of each individual patient first and foremost,” the letter says. “The rapid spread of COVID-19 and the acute needs of patients who have become seriously ill have forced healthcare professionals and institutions across the country to confront the prospect of rationing and the disproportionate impact of disease across the population.”

Specifically, the letter calls into question crisis standard of care plans which seek to allocate resources fairly. Fincher and Harris say that when these plans rely on clinically based considerations of medical need, prognosis, and effectiveness, as well as fundamental standards of equity and fairness. When these plans instead rely on criteria which discriminates “against categories of persons, notably, elderly individuals or individuals with disabilities, they are not ethically defensible.”

The healthcare system must adopt a much more thoughtful and ethically, medically justifiable approach when it comes to clinical resource allocation planning post-COVID-19, according to the letter.

The letter also highlights the disproportionate mortality rate from the disease among residents of long-term care facilities, and in Black, Latinx, and Indigenous populations which are a product of structural barriers to appropriate care.

“To be sure, in the midst of a crisis, resource allocation tools that guide decisions for individual patients cannot by themselves redress deep-rooted problems, especially structural and social determinants that generate long-standing health inequities,” the letter says. “Leveling the playing field will require sustained collective efforts to change not only how society prepares for public health emergencies, but fundamentally how patient care is organized and delivered, moving toward a system that cares for all and directly challenges the taken-for-granted inequities of our current system.”