Whose life to save? Scarce resources allocation in the COVID-19 outbreak

Abstract

After initially emerging in China, the coronavirus (COVID-19) outbreak has advanced rapidly. The World Health Organization (WHO) has recently declared it a pandemic, with Europe becoming its new epicentre. Italy has so far been the most severely hit European country and demand for critical care in the northern region currently exceeds its supply. This raises significant ethical concerns, among which is the allocation of scarce resources. Professionals are considering the prioritisation of patients most likely to survive over those with remote chances, and this news has triggered an intense debate about the right of every individual to access healthcare. The proposed analysis suggests that the national emergency framework in which prioritisation criteria are currently enforced should not lead us to perceive scarce resources allocation as something new. From an ethical perspective, the novelty of the current emergency is not grounded in the devastating effects of scarce resources allocation, which is rife in recent and present clinical practice. Rather, it has to do with the extraordinarily high number of people who find themselves personally affected by the implications of scarce resources allocation and who suddenly realise that the principle of ‘equals should be treated equally’ may no longer be applicable. Along with the need to allocate appropriate additional financial resources to support the healthcare system, and thus to mitigate the scarcity of resources, the analysis insists on the relevance of a medical ethics perspective that does not place the burden of care and choice solely on physicians.

Self-care strategies in response to nurses’ moral injury during COVID-19 pandemic

“…The number of suicides will rise and PTSD will be prevalent and common among nurses. 1 , 2 The unresolved moral distress has been correlated with burnout and long-term consequences such as emotional exhaustion, depersonalization, feelings of disengagement, numbness, and diminished moral sensitivity. 32 These, in turn, are forms of moral injury.…”

“…As the number of confirmed cases continues to rise, nurses face high-stakes, decision-making challenges that affect both their professional and personal lives. 1 , 2 …”

“…Tragically, there has also been a spike in suicides among healthcare professionals in the midst of this pandemic. 2 , 7 …”

The role of Frailty on Adverse Outcomes Among Older Patients with COVID-19

“…20 Thus, it is crucial to determine who would benefit most from intensive care and ventilator support and allocation of scarce resources. 21 However, this concept is both practically and ethically challenging. 22 The different strategies have been adopted in different countries with selective admission of younger patients, and donot-resuscitate labeling has highlighted the problem of "ageism".…”

Ethical Issues in Decision-making Regarding the Elderly Affected by Coronavirus Disease 2019: An Expert Opinion

“…COVID-19 in elderly patients raises some ethical issues; however, most of these issues are similar to ethical problems in other conditions, such as heart failure. [17][18][19] The correct prioritisation for the allocation of scarce resources should be based on various factors relating to the individual. Chronological age should not be the only factor that influences the decision-making process.…”