Unthinkable decisions –
These are choices no doctor wants to make. But they may soon be a reality.
Beth Mole – Mar , () : pm UTC
Meanwhile, the normal stream of patients needing emergency care for accidents, heart attacks, strokes, and other conditions may be lost in the deluge.
Grim reality
Ultimately, how the pandemic plays out in the United States generally and in specific areas is difficult to predict. Social distancing and other interventions could lessen the blow.
“The choice to set limits on access to treatment is not a discretionary decision, but a necessary response to the overwhelming effects of a pandemic, ”they write. “The question is not whether to set affected, but how to do so ethically and consistently, rather than basing decisions on individual institutions’ approaches or a clinician’s intuition in the heat of the moment.”
The authors lay out six recommendations, guided by four fundamental values: maximizing benefits, treating people equally, giving priority to the worst off, and rewarding instrumental value (that is, giving priority to patients who can go on to help others, such as patients who are doctors).
Their first recommendation for how to ethically allocate care in the COVID – pandemic is to prioritize saving the most lives and more years of life. That is, prioritizing people who are sick but likely to recover over those who are unlikely to recover with treatment or don’t need treatment to recover. Because many of the severely ill patients who are most likely to recover are young, this also has the effect of “giving priority to those who are worst off in the sense of being at risk of dying young and not having a full life.”
Because maximizing benefits this way is seen as paramount, the researchers even note that it may be ethically justified for doctors to remove some patients from ventilators or ICU beds if other severely ill patient arrive with better chances of surviving.
If doctors are faced with many similar patients with similar prognoses, the researchers’ third recommendation is that things like beds and ventilators should be allocated randomly, such as in a lottery. This is more ethical than allocating resources in a first-come, first-serve way, they argue. The latter approach may benefit those who simply live closer to health care facilities, may encourage crowding in a time when social distancing is important, and may penalize those who get sick later in the pandemic, possibly because they were trying to adhere to public health measures , such as social distancing.
GIPHY App Key not set. Please check settings