Ethical allocation of resources in paediatrics — OSCE

Objectives

1. Explain a triage allocation decision to a family using transparent, principle-based language. [1]
2. Reassure the family that the decision reflects scarcity, not a judgement that their child's life is worth less. [8]
3. Guarantee that allocation withdraws only the specific intervention and that comfort care continues. [8]
4. Offer the appeal pathway and name the ethics committee. [2] [6]

Candidate brief

A 10-minute station. During a winter surge the last PICU bed has been allocated by the pre-agreed triage protocol to a child with a better short-term prognosis. The candidate must meet the parents of the 4-year-old child who did not receive the bed, a child with a progressive neurodegenerative condition now in respiratory failure. The parents have been told only that the bed went to another child and are distressed and angry, asking whether their child's life is valued less. The candidate must explain the decision, reassure the family, and outline what happens next. [6] [8]

Expected actions

• Set the scene: a private space, both parents present, an interpreter booked if needed, and no interruptions. [8]
• Acknowledge the family's distress before delivering explanation. [8]
• Explain that the decision followed the pre-agreed triage protocol applied by a separate triage officer, not a personal judgement about their child. [6]
• Reassure the family that scarcity, not the worth of their child, drove the decision; reframe allocation as a population decision, not a valuation. [8]
• Guarantee that allocation withdraws only the specific intervention — their child still receives active comfort care, symptom relief and family presence. [8]
• Offer the appeal pathway and name the ethics committee and the documentation that records the criteria used. [2] [6]
• Avoid jargon ('triage', 'resource') without explanation, and avoid any language that implies their child is less deserving. [8]
• Agree a clear plan for comfort care and family support, and name who will review the decision. [8]

Examiner prompts

• "Are you saying my child's life is worth less?" → Reassure that the decision reflects scarcity and a transparent protocol, not a valuation of their child. [8]
• "Who decided this?" → Explain the separation of the triage officer from the treating team and that the protocol is pre-agreed. [6]
• "What happens to my child now?" → Guarantee active comfort care, family presence and symptom relief, and name the review point and the appeal pathway. [8] [2]

Marking foci

• Explains the triage decision in transparent, principle-based language the family can follow. [1] [6]
• Reframes scarcity as the cause, not the worth of the child, and avoids any devaluing language. [8]
• Guarantees that comfort care continues and that allocation withdraws only the specific intervention. [8]
• Offers the appeal pathway and names the ethics committee and the documented criteria. [2]
• Manages the emotional intensity with empathy and a clear, compassionate structure. [8]