Ethical considerations for allocation of scarce resources and alterations in surgical care during a pandemic

Abstract

The COVID-19 pandemic caused by SARS-CoV-2 is unprecedented in modern history. Its effects on social behavior and health care delivery have been dramatic. The resultant burden of disease and critical illness has outpaced the diagnostic, therapeutic, and health care professional resources of many clinics and hospitals. It continues to do so globally. The allocation of hospital beds and ventilators, personal protective equipment, investigational therapeutics, and other scarce resources has required difficult decisions. Clinical and surgical practices which are standard in normal times may not be standard or safe during the COVID-19 crisis. How can we best adapt as physicians and surgeons? What foundational ethical principles and systems of principle application can help guide our decision-making? Fortunately, a large body of work in medical ethics addresses these questions. Unfortunately, many surgeons and other health care professionals are probably not as familiar with these concepts. This brief communication is intended to provide a concise explanation of ethical considerations which readers may find helpful when addressing allocation of scarce resources and alterations in surgical care brought on by the current pandemic.

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“…This has affected certain geographical areas more than others and involved assisting and treating many patients. However, in the event the pandemic were to place a further substantial burden on the health service, employing the same measures as were adopted a few months ago is not an option in that it is not feasible, due to public health and ethical-legal liability concerns as regards sick patients, especially the chronically ill, to impose another substantial suspension on ordinary activities [ 45 , 46 , 47 ].…”

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“…So those are based on the nal population which ts in that initial 20%." IDI 001 female//policy In literature about priority setting for access to scarce resources, there has been a debate about what has been described as the 'fair-innings argument' [33][34][35][36][37] and 'instrumental considerations' [38][39][40]. Part of this argument is that the young, who have not yet had a chance to live and experience life, should get priority because the elderly have already had a chance to live and the youth are more economically productive.…”

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“…With limited resources in the pandemic, the collective benefit is more important than the individual, even though a patient's request for care must be respected, maintaining his autonomy. The impartial distribution of critical respiratory support care, such as mechanical ventilators, is ruled by values that are not usually considered 17 . The protection of justice is under strain, allowing Covid-19 patients with better results to be prioritized over a substantial amount of non-urgent care, which has a negative long-term effect 16 .…”