Lifeboat Ethics: Considerations in the Discharge of Inpatients for the Creation of Hospital Surge Capacity

During a high-consequence event (eg, natural disaster, terrorist strike, infectious disease outbreak), hospitals within health systems function as a lifeboat with a limited capacity to accommodate the medical needs of everyone requiring hospital-level care. Lifeboat ethics was a phrase used first in the 1970s to discuss the distribution of limited food supplies to poverty-stricken nations battling chronic famines.1,2 The growing focus on emergency preparedness and response, however, has given lifeboat ethics a new context within health care: the access to and distribution of limited or scarce lifesaving resources. During a highconsequence event hospitals and health systems balance caring for patients already in the hospital with managing an additional volume of patients with illness or injury related to the event. The Joint Commission on Accreditation of Healthcare Organizations recommends that hospitals have the ability to “surge in place,” with stand-alone operating capacity for up to 3 days.3,4 However, most hospitals and health systems operate daily under constrained capacity, leaving hospitals to face lifeboat situations without the ability to augment capacity and resources, including staff, supplies, and inpatient beds.5,6