Die COVID-19-Pandemie als Prüfstein für gerechte Ressourcenverteilung im Krankenhaus
Eine empirisch-ethische Untersuchung
by Clemens Friedrich Schmidt
Date of Examination:2025-06-05
Date of issue:2025-05-27
Advisor:Prof. Dr. Silke Schicktanz
Referee:Prof. Dr. Silke Schicktanz
Referee:Prof. Dr. Eva Hummers
Referee:Prof. Dr. Friedemann Nauck
Persistent Address:
http://dx.doi.org/10.53846/goediss-11281
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Abstract
English
This dissertation examines the issue of equitable resource allocation in five hospitals during the initial phase of the COVID-19 pandemic, using qualitative expert interviews. The study responds to ethical and organizational challenges posed by the global health crisis, focusing on how frontline healthcare professionals perceived and managed resource scarcity in acute clinical settings. After outlining the research questions and contextualizing the topic with relevant biomedical and ethical background, the study delves into key themes from public health ethics, including distributive justice, organizational fairness, and the allocation of scarce medical resources. A significant gap in existing literature was identified: the lack of empirical insights into the lived experiences and perspectives of healthcare workers during real-time allocation processes under pandemic conditions. To address this gap, twenty semi-structured (telephone) interviews were conducted with staff across different professional groups. Mayring’s qualitative content analysis was applied to evaluate the collected data. The findings are structured along the healthcare system’s multilevel framework, with a focus on the meso level (institutional decision-making). Core resources subject to allocation included personal protective equipment (PPE) and healthcare personnel. PPE shortages were managed by prioritizing high-risk areas and professions, which led to material deficits in other departments, especially those treating patients with different isolation requirements. Personnel shortages—preexisting in the nursing sector—were further intensified, leading to unequal workload distribution and ethical stress among staff. Decision-makers varied across levels: on the macro level, early financial support via emergency legislation played a pivotal role. However, once these subsidies ended, economic incentives increasingly influenced allocation decisions, including the resumption of elective procedures despite high infection rates. On the meso level, hospital crisis committees emerged as key bodies for distribution decisions. These decisions were shaped by institutional communication practices and process quality, which varied in terms of transparency and participation across sites and hierarchical levels. Overall, the sudden resource scarcity created substantial ethical dilemmas for health care workers. While strategies such as rationalization, prioritization, and implicit rationing were implemented to guide allocations, these did not always align with ethical principles or previously established procedural standards. Economization emerged as a critical influencing factor. Many participants reported that economic motives either directly determined or significantly shaped allocation decisions. The resulting consequences included decreased job satisfaction, increased workloads, and potential underprovision of non-COVID-related care, particularly in elective surgery and outpatient services. These findings suggest instances of possible misallocation. In conclusion, the study underscores the need for inclusive, ethically grounded, and interdisciplinary allocation guidelines. Future crisis preparedness should prioritize transparent, participatory decision-making processes to ensure both just resource distribution and the well-being of healthcare staff. Lessons from the pandemic offer valuable insights for optimizing allocation strategies under conditions of scarcity.
Keywords: COVID-19; justice; resource allocation; ethics; scarcity
