Organizational Ethics and a Regional Health-Care Network: navigating surges and shortages in pediatrics

Washington state's plans for a public health response to a pandemic or natural disaster were largely untested prior to the COVID-19 pandemic. Individual institutions were unprepared for a crisis of the scale and severity of the pandemic, and they faced a myriad of ethical questions that required expertise and experience. The pandemic also revealed the fundamental need for local, state, and regional collaboration during times of resource scarcity. As individual institutions scrambled to organize and implement strategies for dealing with scarcity in a way that was both effective and fair, the lack of a regional or national system to organize those efforts impaired a timely response and resulted in duplicated efforts and differing approaches. This article describes the authors' pediatric institutional response to the pandemic within the context of a broader cooperative statewide approach. The authors explain the rationale for starting with a utilitarian framework and the ways in which its shortcomings were addressed. The structures and approaches described continue to be utilized and modified for other situations that lead to resource scarcity of all kinds. Although changes at the national level to create a national response would be ideal, collaboration and investment at the state and regional level is both critical and pragmatic in ensuring that all patients can access the health care they need.