Allocating scarce resources to the time of Covid: who will live when everyone can’t live?

Allocating scarce resources to the time of Covid: who will live when everyone can’t live?

By Jody Cramsie

I’m mad.

Vital treatments are denied to patients. Elective surgeries are canceled and suspended. Do not confuse the benign-sounding term “your choice” with frivolous or optional. Choice refers to procedures that are medically necessary but may not be an immediate emergency. Elective surgeries save lives. If they didn’t, doctors wouldn’t be justified in executing them. And time matters, even with elective procedures – hearts may not continue to beat with a damaged valve; cancerous tumors can metastasize the longer they stay in the body. These patients are getting sicker and some die.

Why is this happening? Hospitals everywhere, including here, are explicitly rationing health care. Hospitals are using their meager resources to treat intentionally unvaccinated Covid patients. Hospitals are overrun and overwhelmed by the overwhelming waves of these Covid sufferers – those people who have made personal and socially destructive decisions and now want to lead the way, despite their own guilt in their current condition. And hospitals agree with that and prioritize these patients over others.

Every fiber of my being says it’s not right. But what does fairness have to do with this? Does equity still matter? What are the biomedical ethical rules and considerations that hospitals use to justify their decisions on this allocation of life or death of scarce resources? Are there other ethically defensible decisions that could be made by these organizations in these perilous times?

There are four fundamental principles recognized in biomedical ethics:

1. Beneficence – the positive obligation to act for the benefit of the patient

2. Non-maleficence – the obligation not to harm the patient

3. Autonomy – the recognition that the patient has the power to make decisions and choices by exercising his capacity for self-determination

4. Justice – the fair and equitable distribution of benefits and burdens

Autonomy requires taking into account the right of the individual to freely make decisions concerning his health. This includes the individual’s ability to understand these choices, including the consequences of the decision. The patient then moves forward voluntarily.

Of course, a person’s autonomy is not uncontrolled; it may be limited when the autonomous action of this person causes prejudice to one or more other persons. While autonomy is primarily about the rights of the individual, justice requires a balance of benefits and burdens between all concerned. It involves social cooperation, serving the common good and maximizing benefits within the system as a whole, while making the difficult choices to balance actions.

Let’s be clear: I’m talking about post-vaccine treatment issues for Covid. I think this is a morally relevant distinction in this discussion of allocating scarce resources. This pandemic can be a crisis of such magnitude that many principles of biomedical ethics could / should be called into question.

In many ways, the voluntarily unvaccinated Covid patient has made his treatment priorities known. They voluntarily took the risk and refused to mitigate any possible harm to themselves, their families and society. Why not respect this autonomous decision when it comes to allocating scarce resources, which at the same time serve the objectives of equity and justice required by justice?

As a result, I suggest that hospitals (not doctors or nurses) could adopt an ethically defensible policy to queue sick Covid patients and not automatically prioritize them. I think this could be done by fully respecting the prior decision of the voluntarily unvaccinated Covid patient to refuse medically appropriate and possibly life-saving treatment.

I think the actions could be balanced by hospitals developing a planned policy, based on principles and justified by a call for ethical standards. It would be well argued with input from ethicists, legal advisers, risk managers, hospital administrators and staff, and other stakeholders. The policy would be announced and widely disseminated so that everyone knows and understands that it is not responsive to any specific individual or group of individuals, but transparent and objective and consistent with the hospital’s mission and responsibility to the hospital. whole community.

The government has not taken the lead on this issue. It has a vital and legitimate role in alleviating the horrific conditions in which hospitals operate. It has left hospitals and communities with the heavy burden of moral distress caused by the forced allocation of hospital resources. The government should mobilize its resources to set up Covid-specific treatment centers, creating space in hospitals for the care of other sick patients. If hospitals, themselves, are setting up temporary treatment areas in staff rooms, hallways and parking lots (!!), then appropriate temporary treatment areas should surely be put in place for Covid patients with government action of first priority.

Autonomy is crucial. Ever increasing levels of self-determination and the development of individual potential are hallmarks of human progress. None of us can live happily or productively without it. But it’s nothing without justice, which is often elusive. It could bring the arc of justice a little closer to the reach of society.

© 2021 SpokaneFāVS

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