The Government has advised medical workers that they face the possibility of “serious moral and emotional distress” due to the difficult choices that may be forced on them during the Covid-19 pandemic.
A newly published document illustrates how the pandemic may put the healthcare system under extreme pressure and, in that context, offers an ethical framework for making difficult decisions about the allocation of scarce resources.
It states that moving from “patient-centred practice to practice guided primarily by public health considerations can cause tension for clinicians, because ensuring the health of the population often entails imposing limitations on the rights and preferences of individual patients”.
The document states that during a pandemic, critical care resources are likely to become limited.
“Once the healthcare system reaches capacity, everybody will be cared for, but may not have the same access to different levels of medical intervention. Decisions will, therefore, have to be made regarding who should be prioritised to receive intervention,” it states.
Emergency thinking
The advice was drawn up in consultation with a wide range of stakeholders in recent weeks in response to the Covid-19 pandemic.
The document is not designed to guide individual clinical decisions at the front line, but to assist healthcare workers in "thinking through the difficult decisions that will need to be made during the course of an emergency", a spokeswoman for the Department of Health said.
It was drawn up by a special Pandemic Ethics Advisory Group, a sub-group of the National Public Health Emergency Team (NPHET), which is driving the State's response to the pandemic. That group includes members from the fields of ethics, medicine, law and patient representation. It was reviewed by senior medical experts and the NPHET before being published.
The document emphasises that in situations where all patients cannot be treated, decision-making should be conducted in a consistent manner. “Decisions will have to be made about the level of care offered eg admission to ICU, initiation of life-sustaining treatment eg ventilation, as well as withholding or withdrawal of life-sustaining treatment, necessitating referral to palliative care services.
‘Maximising’ benefit
“Fairness dictates that these decisions should be based on the underlying rationale of maximising the benefit that can be gained from the limited amount of resources available.”
It advises that the starting point for a rationing decision “is to consider which patients are most likely to benefit from the intervention”.
Dr Donal O’Hanlon, president of the Irish Hospital Consultants’ Association, said the publication “is a responsible and co-ordinated response to support healthcare staff in this challenging situation”.
“These guidelines will support our clinical decision-makers in making decisions on how best to utilise healthcare resources under the current challenging conditions.”
He said Irish patients would “continue to be cared for with compassion, transparency and dignity, with their best interests to the fore”.
