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  1. Article ; Online: Ethical considerations in the allocation of critical care resources when capacity is overwhelmed.

    Pauls, Merril A / Migneault, David / Bakewell, Francis

    CJEM

    2020  Volume 22, Issue 4, Page(s) 404–406

    MeSH term(s) Critical Care ; Humans ; Resource Allocation
    Keywords covid19
    Language English
    Publishing date 2020-03-30
    Publishing country England
    Document type Journal Article
    ISSN 1481-8043
    ISSN (online) 1481-8043
    DOI 10.1017/cem.2020.354
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Book ; Online: Ethical Considerations Relating to Critical Care in the context of COVID-19

    Department of Health (DoH)

    2020  

    Abstract: ... regarding the prioritisation of critical care resources in the context of COVID-19. The guidance is ... as a whole. Where intensive care resources become limited, it is ethically necessary, justifiable and ... intensive care are treated according to the same criteria. Available resources are to be allocated fairly and ...

    Abstract The following guidance is directed to clinical staff who will be involved in making decisions regarding the prioritisation of critical care resources in the context of COVID-19. The guidance is applicable to the particular situation where resource scarcity arises and rationing decisions have to be made and are applicable to all patient categories. Patients with COVID-19 and other patients requiring intensive care are treated according to the same criteria. Available resources are to be allocated fairly and in a consistent manner. In response to the COVID-19 pandemic and in anticipation of a significant increase in demand for resources, measures have been and are being taken to increase capacity in the Irish healthcare system, including in relation to intensive/critical care capacity. As part of the process of preparation for dealing with a pandemic and building “surge capacity” it is necessary to make difficult choices in terms of the availability of certain health services (e.g. deferring non-essential appointments, cancelling elective surgeries, transferring patients, etc) to ensure staff, space, and resources are available. COVID-19 is associated with acute respiratory illness, and clinical evidence indicates that a substantial proportion of patients become seriously ill, requiring respiratory support (e.g. oxygen, ventilation, etc) and admission for intensive care treatment. Therefore, notwithstanding the measures taken to build surge capacity, as part of the pandemic preparedness process, it should be anticipated that healthcare resources, particularly in the context of intensive care, are likely to be severely limited and potentially overwhelmed as the impact of COVID-19 increases and the number of cases increases. In public health emergencies, clinicians will have to adapt their normal practice in order to appropriately respond to the needs of the population. Faced with unprecedented demands, clinicians may need to replace normal standards of care with ‘contingency standards of care’1 until such point as the pandemic is determined to have been brought under control. This creates a tension between a healthcare professional’s duty of care for individual patients and the broader public health consideration of maximising the number of lives saved, and overall health gain, of the population as a whole. Where intensive care resources become limited, it is ethically necessary, justifiable and proportionate to have mechanisms/decision tools in place to enable healthcare professionals to triage and prioritise access to those resources. In line with the ethical principle of fairness there should be processes to guide the distribution of burdens and benefits across members of society so that no individuals or groups shoulder a disproportionate burden or benefit in a disproportionate way, relative to others. Healthcare planners, managers and clinical staff have a duty to use limited resources prudently and fairly to minimise the loss of life and suffering and produce the maximal benefit possible for individuals served by those interventions.
    Keywords CORONAVIRUS ; COVID-19 ; INTENSIVE CARE ; MEDICAL ETHICS ; covid19
    Subject code 360
    Language English
    Publishing date 2020-04-03
    Publisher Department of Health (DoH)
    Publishing country ie
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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