Dutch public: doctors should decide about the allocation of IC beds

ESB

Dutch adults believe that doctors, together with healthcare experts, should draw up uniform rules about who should get a bed assigned in the ICU. Personal characteristics should not play a role in this decision. Instead, urgency, prognosis, and the risk of infection are important characteristics that should be taken into account when making this decision.

Health economist Prof. Job van Exel, behavioral economist Prof. Kirsten Rohde, with PhD candidate Merel van Hulsen of Erasmus School of Economics, asked a thousand Dutch adults the following two questions: If the intensive care capacity in the Netherlands was insufficient, which patients would deserve an ICU bed? And in that case, who should be responsible for making this difficult decision?

Previous research outcomes

Previous research into the distribution of limited resources in healthcare shows that the Dutch population generally considers access to care and equal treatment to be the most important factors. In addition, they believe that characteristics such as the severity of the condition, the effectiveness of the treatment, and the quality of life after treatment should play an important role when making choices regarding the ICU. Personal characteristics, unhealthy behaviour, and money should not play a role in these decisions. The current circumstances due to the coronavirus are reviving the debate about which patients should be given priority. The researchers have therefore drawn up the above questions for a thousand Dutch people who are representative of the population in terms of age, gender and education. 

Trust in doctors

In response to the question about who should determine which patients should be given priority to ICU beds, the researchers have drawn up ten answer options. The answers showed that the Dutch mainly entrust this choice to the doctor. A number of participants indicated that they find it important that guidelines are drawn up nationwide so that the same rules apply in all hospitals. It seems undesirable for doctors to have to make the choice individually. This is seen as too heavy a burden. What is also striking is that the respondents only saw a small role for the government and politicians in drawing up general guidelines. The option of raffling off ICU beds or allowing citizens to take part in deciding on the guidelines seems undesirable by most respondents. 

Personal characteristics should not play a role

In response to the question about which patients should be given an ICU bed, eighteen criteria were presented, based on previous literature. The statement 'Personal characteristics should not play a role' received most approval. More than sixty percent of the respondents agreed. Five other criteria also received approval from more than fifty percent of the respondents. Three of these criteria related to people who have a higher risk of infection because they work in a vital profession or are involved in the development of a treatment against the virus. The other two criteria related to patients who are most vulnerable and those who have the highest chance to fully recover - criteria that generally do not go well together.

Appreciation

The study also found that many of the criteria in the answer options were considered to be neutral. This can be seen as an indication that many participants find it difficult to decide which patients should be prioritized and prefer to leave this choice in the hands of doctors and experts. All in all, it seems that the Dutch population trusts our doctors and experts when it comes to making well-considered decisions about the distribution of ICU beds. This also shows the great appreciation for all healthcare workers and people in vital professions the public has. 

More information

The full article from ESB can be downloaded above (in Dutch).