What is common and what is different: recommendations from European scientific societies for triage in the first outbreak of COVID-19

Sarmento, Joana Teles; Pedrosa, Cristina; Carvalho, Ana Sofía

doi:10.1136/medethics-2020-106969

Cited by 13 publications

(15 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our findings highlight the tension between Avoiding both arbitrariness and overreliance on apparently objective medical criteria when allocating limited resources during the pandemic, an observation consistent with other published analysis of ICU triage guidelines, including studies by Jöbges et al [ 15 ] and Teles Sarmento et al [ 16 ]. Teles Sarmento et al’s analysis acknowledges that while medical criteria are fundamental, these criteria may not be sufficient in guaranteeing equity among patients [ 16 ]. In seeking defensible non-arbitrariness and consistency, many guidelines appeal to medical criteria such as illness severity or frailty scores to provide a potentially transparent and objective way of ranking patients.…”

Section: Discussionsupporting

confidence: 89%

“…Our analysis makes use of a general understanding of the consequentialist approach in philosophy and bioethics, specifically the form of this that is commonly operational in healthcare contexts, which is to maximise benefits in the form of saving the largest number of lives. In their analysis, Jöbges et al [ 15 ] and Tele Sarmento et al [ 16 ] similarly note general agreement in appealing to the principle of maximising benefit measured by lives or life years saved.…”

Section: Resultsmentioning

confidence: 92%

“…Several ethical analyses of international guidelines for allocating ICU resources during the COVID-19 pandemic have since been published [ 15 , 16 ]. Jöbges et al, for example, found that justice and maximizing benefit were the two normative foundations of the 11 guidelines they reviewed, and they concluded by recommending largely procedural ethical guidance for ensuring that benefits are maximized under conditions of equity and equality.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ethical Guidance for Hard Decisions: A Critical Review of Early International COVID-19 ICU Triage Guidelines

et al. 2021

View full text Add to dashboard Cite

This article provides a critical comparative analysis of the substantive and procedural values and ethical concepts articulated in guidelines for allocating scarce resources in the COVID-19 pandemic. We identified 21 local and national guidelines written in English, Spanish, German and French; applicable to specific and identifiable jurisdictions; and providing guidance to clinicians for decision making when allocating critical care resources during the COVID-19 pandemic. US guidelines were not included, as these had recently been reviewed elsewhere. Information was extracted from each guideline on: 1) the development process; 2) the presence and nature of ethical, medical and social criteria for allocating critical care resources; and 3) the membership of and decision-making procedure of any triage committees. Results of our analysis show the majority appealed primarily to consequentialist reasoning in making allocation decisions, tempered by a largely pluralistic approach to other substantive and procedural values and ethical concepts. Medical and social criteria included medical need, co-morbidities, prognosis, age, disability and other factors, with a focus on seemingly objective medical criteria. There was little or no guidance on how to reconcile competing criteria, and little attention to internal contradictions within individual guidelines. Our analysis reveals the challenges in developing sound ethical guidance for allocating scarce medical resources, highlighting problems in operationalising ethical concepts and principles, divergence between guidelines, unresolved contradictions within the same guideline, and use of naïve objectivism in employing widely used medical criteria for allocating ICU resources.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Resultsmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ethical Guidance for Hard Decisions: A Critical Review of Early International COVID-19 ICU Triage Guidelines

et al. 2021

View full text Add to dashboard Cite

show abstract

“…9,27,28 This explains why student nurses may have perceived that they were unable to care for all patients equally. Moreover, previous studies 29,30 have described a great variability in the criteria for prioritizing patient care during the COVID-19 pandemic, which can lead to conflicts and ethical dilemmas among healthcare professionals. 31,32 For example, showing differences in triage between older and younger patients.…”

Section: Discussionmentioning

confidence: 99%

Ethical challenges during the COVID-19 pandemic: Perspectives of nursing students

Palacios‐Ceña

Velarde‐García

Espejo³

et al. 2021

Nurs Ethics

View full text Add to dashboard Cite

Background: The first wave of the COVID-19 pandemic caused a shortage of qualified nurses in Spain. As a result, the government authorized the hiring of senior students. Objectives: To explore the ethical dilemmas and ethical conflicts experienced by final-year nursing students who worked during the first outbreak of the COVID-19 pandemic in Spain. Research design: A qualitative exploratory study was conducted using purposive sampling. Semi-structured interviews were carried out using a question guide. Interviews took place via a private video chat room platform. A thematic, inductive analysis was performed of the information gathered. Participants and research context: Eighteen nursing students were recruited from two universities of Madrid, aged between 18 and 65 years old, enrolled in the fourth year of nursing studies and who were hired under a relief contract for health professionals during the pandemic. Ethical considerations: The present study was carried out in accordance with the Declaration of Helsinki, and the study was approved by the Local Ethics Committee of Universidad Rey Juan Carlos. Results: Three specific themes emerged: (a) coping with patient triage, (b) difficulties in providing end-of-life care, and (c) coping with patient death. Nursing students participated in the process of patient selection for resource allocation and ICU bed occupancy. They were shown how to care for patients who were not admitted to the ICU, in their last moments and were faced with the difficulties of applying end-of-life care. Finally, the nursing students were confronted with the death of their patients, in overwhelming numbers and under adverse conditions. Conclusions: These findings can help shed light on the ethical dilemmas and ethical conflicts faced by novice nursing students, incorporated into the workforce during the COVID-19 pandemic. Moreover, it was described that students may normalize the death due to the exhaustion and overwhelmed routine.

show abstract

“…The prioritization criteria during a pandemic are both a clinical and legal-administrative decision with ethical repercussion. The criteria proposed by European scientific societies differ in some aspects from the recommendations of bioethics committees (5).…”

Section: Introductionmentioning

confidence: 97%

Bioethical Concerns During the COVID-19 Pandemic: What Did Healthcare Ethics Committees and Institutions State in Spain?

Ruíz-Hornillos

Suárez

Martínez

et al. 2021

Front. Public Health

View full text Add to dashboard Cite

Objectives: Each new wave of the COVID-19 pandemic invites the possible obligation to prioritize individuals' access to vital resources, and thereby leads to unresolved and important bioethical concerns. Governments have to make decisions to protect access to the health system with equity. The prioritization criteria during a pandemic are both a clinical and legal-administrative decision with ethical repercussion. We aim to analyse the prioritization protocols used in Spain during the pandemic which, in many cases, have not been updated.Method: We carried out a narrative review of 27 protocols of prioritization proposed by healthcare ethics committees, scientific societies and institutions in Spain for this study. The review evaluated shared aspects and unique differences and proffered a bioethical reflection.Results: The research questions explored patient prioritization, the criteria applied and the relative weight assigned to each criterion. There was a need to use several indicators, being morbidity and mortality scales the most commonly used, followed by facets pertaining to disease severity and functional status. Although age was initially considered in some protocols, it cannot be the sole criterion used when assigning care resources.Conclusions: In COVID-19 pandemic there is a need for a unified set of criteria that guarantees equity and transparency in decision-making processes. Establishing treatment indications is not the aim of such criteria, but instead prioritizing access to care resources. In protocols of prioritization, the principle of efficiency must vary according to the principle of equity and the criteria used to guarantee such equity.

show abstract

What is common and what is different: recommendations from European scientific societies for triage in the first outbreak of COVID-19

Cited by 13 publications

References 14 publications

Ethical Guidance for Hard Decisions: A Critical Review of Early International COVID-19 ICU Triage Guidelines

Ethical Guidance for Hard Decisions: A Critical Review of Early International COVID-19 ICU Triage Guidelines

Ethical challenges during the COVID-19 pandemic: Perspectives of nursing students

Bioethical Concerns During the COVID-19 Pandemic: What Did Healthcare Ethics Committees and Institutions State in Spain?

Contact Info

Product

Resources

About