Multicultural ethics in crisis: prioritizing ECMO allocation and the role of critical consciousness.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.