| Course | DNP 820 Health Policy and Advocacy |
|---|---|
| Module | Module 6 |
| Paper type | Ethics in policy paper |
| Length | About 1,010 words, 6 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | DNP |
| Updated | September 2026 |
Free sample paper for DNP 820 Module 6
Who Gets the Last Ventilator? Ethical Principles, Equity and the Revision of a State's Crisis Standards of Care
Student Name
Doctor of Nursing Practice Program, Aspen University
DNP 820: Health Policy and Advocacy
Instructor Name
Month Day, Year
Who Gets the Last Ventilator? Ethical Principles, Equity and the Revision of a State's Crisis Standards of Care
When a resource is truly scarce, some patients who could benefit will not receive it, and a policy must decide who does. During the COVID-19 pandemic, many states and hospital systems wrote or revised crisis standards of care to guide allocation of ventilators and intensive care beds if demand exceeded supply. Those policies raised hard ethical questions and drew criticism from disability and civil rights advocates. This paper reviews a composite state's crisis standards, examines the ethical principles behind allocation, evaluates the policy's scoring system against equity concerns, and recommends revisions that a nurse on the state's ethics advisory committee could propose.
Ethical Principles for Allocation
Allocation principles fall into several families. Treating people equally can be pursued through a lottery or through first-come, first-served, although the latter favors those with better access. Favoring the worst off can mean giving priority to the sickest or to the youngest, who would otherwise lose the most life. Maximizing total benefit can mean saving the most lives or the most life-years. Promoting and rewarding social usefulness can mean giving priority to those, such as health workers, whose survival helps others. An influential analysis argued that no single principle suffices and proposed a combination, a complete lives system, that gives priority to younger people while also considering prognosis, saving the most lives and lottery, and rejects allocation by ability to pay or first-come, first-served (Persad et al., 2009).
Recommendations written early in the pandemic applied these principles to COVID-19. They included maximizing benefits, both lives and life-years saved; giving priority to health workers; not using first-come, first-served; using random selection among patients with similar prognoses; and updating criteria as evidence emerges (Emanuel et al., 2020).
The State's Scoring System
The composite state's policy adapted a widely circulated framework in which patients receive a priority score based on their likelihood of surviving the hospitalization, measured by an organ failure score, and their likelihood of longer-term survival, based on severe comorbid conditions expected to cause death within a few years. Patients with the lowest scores receive priority, and ties are broken by age, favoring younger patients, and then by other factors. The framework's authors intended it to be applied by a triage team separate from the treating clinicians and to be reassessed regularly (White & Lo, 2020). The state's version also included a provision allowing reallocation of a ventilator from a patient who was not improving to one with a better prognosis.
The policy was written quickly, by a small group of physicians and administrators, and was posted on the state health department's website without a formal comment period. Nurses, disability organizations and community groups had no seat at the table. When its contents became public, the process itself became a source of distrust, separate from the substance of the criteria.
Equity Concerns
Disability advocates raised several objections to policies like this one. Criteria based on long-term survival can disadvantage people with chronic illnesses and disabilities for reasons unrelated to their chance of surviving the current illness. Some early policies from other states excluded people with specific conditions or used functional status, which penalizes disability directly, and federal civil rights officials warned that crisis standards must not discriminate on the basis of disability. Reallocation provisions raised fears that people who use ventilators in daily life could lose their own equipment.
Racial equity concerns followed. Organ failure scores include laboratory values, such as creatinine, that may be higher in some groups because of prior disparities in chronic disease, and long-term survival criteria reflect conditions that are more common in communities with less access to care. A policy that appears neutral can therefore reproduce existing inequities, allocating fewer resources to groups already harmed by structural disadvantage.
Recommended Revisions
A nurse serving on the state's ethics advisory committee could recommend five revisions. First, remove long-term survival criteria and base priority only on the likelihood of surviving the current episode, which reduces penalties for chronic conditions and disability. Second, prohibit the use of functional status, quality of life judgments and categorical exclusions. Third, protect personal ventilators, so that no one who brings a ventilator to the hospital loses it through reallocation. Fourth, require that triage decisions and outcomes be recorded by race, ethnicity, age and disability so that disparities can be detected and corrected. Fifth, include disability, racial justice and faith community representatives in future revisions and require public comment.
The revisions accept the principle of maximizing lives saved in the current crisis while rejecting criteria that convert existing disadvantage into lower priority. Some ethicists would argue that giving up life-years as a criterion sacrifices total benefit; the committee must weigh that loss against the fairness concerns and against the weak evidence that long-term survival predictions are accurate for individuals.
The Nurse's Role
Nurses are central to crisis standards in practice. They care for patients whose treatment is limited, often communicate decisions to families and experience the moral distress of withholding or withdrawing care they would otherwise provide. Nurses therefore bring a perspective policymakers need: what a policy looks like at the bedside, what families understand and what support staff need. Nurses should be members of triage teams and ethics committees, and policies should include provisions for staff support and debriefing.
Nurses can also help ensure that policies are understood before a crisis. Training on the triage process, scripts for conversations with families and clear escalation routes reduce the chance that bedside staff will improvise rules under pressure.
Conclusion
Crisis standards of care force explicit choices about who receives scarce life support. Ethical frameworks offer guidance but disagree, and scoring systems that appear neutral can disadvantage people with disabilities and communities of color. Revising the composite state's policy to focus on short-term survival, prohibit disability-based criteria, protect personal ventilators, monitor equity and include affected communities would make it fairer while keeping its core aim of saving the most lives. Nurses, who carry out these policies at the bedside, should help write them.
References
Emanuel, E. J., Persad, G., Upshur, R., Thome, B., Parker, M., Glickman, A., Zhang, C., Boyle, C., Smith, M., & Phillips, J. P. (2020). Fair allocation of scarce medical resources in the time of Covid-19. New England Journal of Medicine, 382(21), 2049-2055. https://doi.org/10.1056/NEJMsb2005114
Persad, G., Wertheimer, A., & Emanuel, E. J. (2009). Principles for allocation of scarce medical interventions. The Lancet, 373(9661), 423-431. https://doi.org/10.1016/S0140-6736(09)60137-9
White, D. B., & Lo, B. (2020). A framework for rationing ventilators and critical care beds during the COVID-19 pandemic. JAMA, 323(18), 1773-1774. https://doi.org/10.1001/jama.2020.5046
Reading the DNP 820 Module 6 assignment instructions
Aspen's DNP 820 prompts are available only in the classroom; this sample is pinned to the course description of policy reform through ethical and societal contexts. An ethics in policy paper usually asks you to choose a policy with ethical tension, apply named principles or frameworks, analyze effects on vulnerable groups, and recommend changes. Check whether your prompt requires a specific ethical framework, such as principlism or the ANA Code of Ethics, whether the policy must be real, and whether a nursing role must be addressed. Length and source counts are set in the assignment. Plan to use ethics literature as well as policy documents, since an ethics paper built only on clinical studies misses the heart of the assignment.
How the DNP 820 Module 6 example is put together
The example is about 1,010 words in six sections. It opens with ethical principles for allocation, grouping them so that each can be linked to a published recommendation. The state's scoring system section explains how the priority score works, including its use of organ failure scores and predicted long-term survival. Equity concerns explain how scores and survival predictions can disadvantage people with disabilities and groups with higher chronic disease rates. Recommended revisions give five specific changes, each tied to a principle. The nurse's role section describes what a nurse ethicist or committee member can do. The conclusion balances the goal of saving lives with the demands of fairness, which is the tension the whole paper examines.
DNP 820 Module 6 rubric: what earns full marks
Ethics papers are graded on how well you apply principles, not on how strongly you hold an opinion. This example earns application points by tying each part of the policy and each revision to a named principle, and the margin notes show where the framework does the analytic work. The equity section addresses a criterion many doctoral rubrics include on diversity or social justice. Specific revisions support the recommendations row. The nurse's role meets the implications criterion. Organization moves from principles to policy to critique to revision. APA points depend on citing ethics sources, policy documents and research correctly, and on presenting contested ideas in neutral, precise language rather than advocacy rhetoric.
Common DNP 820 Module 6 mistakes, and how to avoid them
Students often write about crisis standards as if the answer were obvious, which ignores the real tension between saving more lives and treating people equally. Name the tension and work through it. Another frequent error is listing principles without applying them to specific parts of the policy. Link each principle to a feature of the score. Papers also misunderstand disability objections, treating them as opposition to triage rather than as concerns about specific criteria, such as long-term survival predictions. Some students recommend abolishing allocation rules entirely, which is not realistic during a real shortage. Recommend revisions instead. Finally, keep your tone measured, because rubrics reward balanced reasoning more than moral certainty.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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DNP 820 Module 6 questions, answered
What does DNP 820 Module 6 usually ask for?
Aspen's DNP 820 description includes the ethical contexts of policy reform, so analyzing the ethics of a policy that allocates a scarce resource is a typical assignment. Check your classroom for the prompt.
What are crisis standards of care?
Policies that guide how health care is delivered and scarce resources are allocated when demand overwhelms capacity, such as during a pandemic or disaster.
Why do disability advocates object to some allocation policies?
Because criteria such as long-term survival, functional status or categorical exclusions can lower priority for people with disabilities for reasons unrelated to their chance of surviving the current illness.
Where can I find a free DNP 820 Module 6 sample paper?
One is reproduced on this page: an ethics in policy paper on a state's ventilator allocation rules, annotated beside each section and open to every reader. If your prompt centers on a different policy, you can order a custom paper with the form at the top.
What ethical framework fits DNP 820 Module 6?
Principlism, with autonomy, beneficence, nonmaleficence and justice, is a common choice, and the ANA Code of Ethics adds nursing's perspective. For allocation policies, frameworks that group principles by aims, such as saving the most lives or treating people equally, work well, as in this example.