CORONA ETHICS
Two COVID 19 positive critical cases with one
ventilator whom to save?
This situation is being faced by Italy
Coronavirus is forcing doctors to decide who they’ll
save
Dr K K Aggarwal
President CMAAO, HCFI and Past national President IMA
For
A lack of resources could mean that younger, healthier
patients are prioritised, while others are left to die. Currently Italy is
facing serious challenges, with demand for critical care far outstripping
supply. Health officials there are having to make very difficult decisions
about who to treat – in the knowledge that deciding not to treat will very
likely lead to death.
As per Italian College of Anesthesia, Analgesia,
Resuscitation and Intensive Care, guidelines advising doctors how to deploy
scarce resources when the need for them is outstripped by the demand of
critically ill patients. The guidelines state that priority should be given to
those who have, first, “greater likelihood of survival and, second, who have
more potential years of life”.
As a result, patients with underlying conditions and elderly
patients, who are deemed to stand less chance of surviving the virus, may not
be treated in favour of healthier and/or younger people who have more chance of
recovery.
Against
Utilitarianism – which aims at maximising the number of
lives saved. This approach does not value any one life over another – all lives
are equally valuable – but it does say that we should focus resources where
they are likely to save the most lives. This prefer “first come, first served”
queuing system. That seems familiar, impartial, equitable and fair.
That may well be the best strategy in normal times – but a
pandemic is not normal. It is an emergency, and while emergencies do not call
for a suspension of ethics, they do call on us to revisit our priorities – and
that will always be horribly uncomfortable.
Situations
1.
Person first in the queue is suffering from
Covid-19. He is an older – but not elderly – person, with an underlying lung
condition that means they need critical care. Treatment would not be futile –
it might save their life – but to choose to treat them would require an
extended period of critical care and the outcome would be uncertain.
2.
The next two people in the queue are of similar
age and have been hit hard by the virus, but they do not suffer with underlying
lung problems. They are more likely to survive. They also need critical care to
get them over the worst effects of the virus, but because they have no
underlying health conditions they will pass out of the danger zone faster,
meaning that both of them are likely to be saved in less time, and for less
resource, than it would take to try to save the first patient.
In this scenario, assuming that all three cannot be given
critical care, it appears to make sense to treat the person who will take up
fewer resources with a more certain outcome and free up the bed faster.
The knock-on effect is that elderly people and those with
underlying health conditions – who are less likely to benefit from treatment
and would take longer to see benefits – might not receive treatment.
