Connelly Yaron, Barnea Royi, Tur-Sinai Aviad, Tal Orna
ICET- The Israeli Center for Emerging Technologies, Zrifin, Israel.
Assuta Health Services Research Institute, Assuta Medical centers, Tel Aviv-Yafo, Israel.
Int J Equity Health. 2025 Aug 12;24(1):221. doi: 10.1186/s12939-025-02597-x.
Allocation of lifesaving technologies is a worldwide dilemma and the Covid-19 pandemic unprecedently amplified this scenario; medical teams struggled to fight the disease while demand for ECMO devices for severe patients exceeded the supply. Allocation of scarce technologies embedded socio-ethical perspective beyond clinical consideration, and we faced cultural and personal conflicts during the decision-making process. This study explores the multicultural Israeli healthcare arena, in which Arab and Jewish healthcare professionals treat Arab and Jewish patients equally, with a specific focus on the allocation of lifesaving resources and the role of cultural preferences in shaping these decisions.
A nationwide survey was conducted among healthcare professionals during an advanced managerial academic program. A structured questionnaire was produced and referred to a scenario in which the number of Covid-19 patients who need ECMO treatment exceeded the number of available devices. Participants were asked to set allocation preferences regarding theoretical patients representing different sociodemographic statuses and reasonably justify their choices.
226 participants completed the survey. 60% of the Jewish, compared to 40% of the Arab participants declared no one should be prioritized. However, Arab participants showed a significant preference for prioritizing two age groups: the elderly and the youngest. For both Jewish and Arab participants, the main justification for prioritizing young patients was their better survival chances. In contrast, the reasons for favoring the elderly differed significantly between the groups; Arabs emphasized respect for "wisdom and social dignity," while Jews highlighted eligibility based on past insurance payments.
Differences in perceptions and a range of values between Jewish and Arab participants were observed. Socio-ethical understanding and implementation of critical consciousness, offers an opportunity to increase 'doing good', assist in peers' support in complex situations and can affect the shaping of the next generation of healthcare managers.
救生技术的分配是一个全球性难题，而新冠疫情使这一情况空前加剧；医疗团队在抗击疾病的同时，重症患者对体外膜肺氧合（ECMO）设备的需求超过了供应。稀缺技术的分配嵌入了临床考量之外的社会伦理视角，我们在决策过程中面临文化和个人冲突。本研究探讨以色列多元文化的医疗领域，其中阿拉伯和犹太医疗专业人员平等对待阿拉伯和犹太患者，特别关注救生资源的分配以及文化偏好对这些决策形成的作用。
在一个高级管理学术项目期间，对医疗专业人员进行了全国性调查。编制了一份结构化问卷，涉及新冠患者需要ECMO治疗的人数超过可用设备数量的情景。要求参与者对代表不同社会人口统计学状况的理论患者设定分配偏好，并合理说明其选择的理由。
226名参与者完成了调查。60%的犹太参与者与40%的阿拉伯参与者表示不应有优先顺序。然而，阿拉伯参与者显著倾向于优先考虑两个年龄组：老年人和最年幼者。对于犹太和阿拉伯参与者而言，优先考虑年轻患者的主要理由是他们有更好的生存机会。相比之下，两组中支持老年人的原因有显著差异；阿拉伯人强调尊重“智慧和社会尊严”，而犹太人则强调基于过去保险支付情况的资格。
观察到犹太和阿拉伯参与者在认知和一系列价值观上存在差异。社会伦理理解和批判性意识的实施，为增加“做好事”、在复杂情况下协助同行提供支持以及影响下一代医疗管理者的形成提供了机会。
