Discussions on Ventilator Allocation in Japan during the COVID-19 Pandemic

Abstract On March 30, 2020, as volunteers of the Biomedical Ethics Study Group, we prepared an article entitled “Recommendations for Establishing a Ventilator Allocation Process during the COVID-19 Pandemic,” which was published on the group’s website and subsequently received various criticisms in Japan. In this current study, we categorized these criticisms into two types: those directed at the recommendations as a whole and those concerning the individual contents presented. We then examined the criticisms’ validity and highlighted the issues that need to be addressed in the future. These issues included measures to limit situations wherein triage is applied, the impact of the triage flowchart on the sense of responsibility among medical and nursing careworkers, a law approach to protect these healthcare providers and medical institutions implementing triage, criteria for maximizing the number of lives saved, measures to guarantee patients’ voluntary will in withholding or withdrawing treatment for triage, a system for implementing triage in the community, and the appropriate crisis standard of care during a pandemic. Assuming that all ethical, legal, and other issues related to triage must be fully resolved before its implementation, especially in a situation where the timing of an outbreak is uncertain, seems inappropriate. However, to respond as effectively as possible to future pandemics, healthcare institutions need to address these issues and establish a valid system now, even if only incrementally.