British doctors have been warned that they may face a difficult choice when treating critically ill patients infected with the coronavirus – who to give life-saving therapy to and who to leave without it. The British Medical Association on Thursday released a new edition of its recommendations for medical ethics during a Covid-19 pandemic.
The recommendations describe the current situation in British healthcare as unprecedented, but despite the efforts of medical professionals, British hospitals may not be able to cope with the influx of patients, as the document emphasizes.
Recently, the UK government purchased several thousand artificial lung ventilators, which, along with other life-support equipment, are needed by the most critically ill patients and can potentially save their lives.
Doctors regularly make difficult decisions in the course of their work, but in the conditions of a pandemic they will have to do so much more often, according to the recommendations. Often, they will have to make choices based on the treatment available.
Here are the key points of the medical association’s recommendations:
- Physicians are advised to consider the following factors:
Hospital administrators and senior physicians are advised to strictly limit the use of intensive care units and to place only the most critically ill patients on ventilators.
A single coronavirus infection should not guarantee preferential treatment, according to the association.
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Patients whose condition is not severe enough to warrant admission to the ICU are not sent there. At the same time, the criteria for determining whether a patient can be connected to a mechanical ventilator are determined by the hospital management.
Chairman of the Association’s Ethics Committee, John Chisholm, said: “It is clear from the newspaper headlines that a ‘tsunami’ of Covid-19 patients is inevitably heading for London hospitals and then the whole of the UK”. “Despite heroic efforts to increase availability and reduce demand for medical services, there is a possibility that intensive care units will be overwhelmed by a wave of patients and there will not be enough beds, ventilators or ECMO machines (to oxygenate the blood – BBC note),” he said. “As everyone who works with us knows, recommendations, while necessary, are not an attempt to solve these monstrously complex ethical issues,” the doctor added. “Recommendations can suggest how to act in a particular situation. They will not make the choice any less painful, and they will not relieve the moral responsibility of those who make decisions.”
In anticipation of the peak of the epidemic, a temporary hospital with a capacity of 3,300 beds is set up at the London Exhibition Centre. Medical ethics specialist and attorney Daniel Sokol comments on the recommendations: “They highlight the issues and dilemmas that physicians will face, but in practice, not everyone will understand how to implement them. For many, this may lead to frustration”. “The recommendations say that a large number of people may need intensive therapy, but there will not be enough resources. However, we do not see a clear answer to the question of how to select patients from this large group,” he believes.