Ethical Dilemmas In The Coronavirus Era: What Lives Should Be Saved?

Ethical Dilemmas In The Coronavirus Era: What Lives Should Be Saved?

Although the Centers for Disease Control and Prevention (CDC) outlines general principles, it is up to each hospital, health system, and state to decide policy. The result is a mixed system. States like New York and Minnesota have detailed guidelines for resource allocation; Others have not talked much about it.

COVID-19 Algorithms

Bioethics experts and hospital leaders from across the country are now discussing online how to formulate COVID-19 algorithms, brainstorm, and share policy drafts in hopes of ensuring equity.

Clinical Professor

“We don’t want a situation where we put doctors by the beds, with the role of making decisions patient by patient,” said Felicia Cohn, clinical professor of bioethics at UC Irvine School of Medicine.

Health Decisions

Setting clear guidelines is also important to the public. Shifting from routine to extreme emergency care during a crisis can be perplexing for those who are denied care, and families who are suddenly no longer allowed to visit or help make health decisions.

“People are used to certain rights and privileges,” Cohn admitted. “In a public health crisis, the context changes completely. We stop enjoying rights that we normally would have.”

In determining who should receive treatment when resources are scarce, experts say that the most pressing criterion is the possibility of survival: who is more likely to die and who can be saved?

More clinical guidance is needed to determine the chances of a coronavirus patient recovering, but new information is emerging. A recent study of infected adults in mainland China showed that the elderly, as well as those showing signs of sepsis or underlying problems like hypertension and diabetes, were at increased risk of death.

Faced with a tiebreaker choice – how to allocate resources to people with a similar probability of survival – health workers could resort to a secondary criterion: Who would have the greatest long-term benefit?

Someone with a longer potential life could have a greater benefit than someone who has already lived long.

A third criterion could be: Are you a health worker, who would go on and could save more people?

Some argue that those who work to save lives, such as respiratory therapists or intensive care physicians, deserve higher priority because they are needed to return to the fight and avoid further deaths in the future.

Health systems have long faced ethical questions about how to allocate limited resources.

“The organs are rationed every day, and many people who do not have the possibility of having a transplant die,” said Arthur L. Caplan, chief of the division of medical ethics at the New York University School of Medicine, in that city, which runs the Bellevue Hospital.

And in the past two decades, a series of infectious disease outbreaks – SARS, H1N1, and Ebola – have depleted resources and sometimes forced doctors to offer specialized treatment only to the most critically ill patients. The reports were archived and forgotten.

“The final act of most pandemics is amnesia,” said Markel. “We have received many warnings. This type of crisis has been talked about for at least 20 years. But we all tend to go back to normal later.”

Experts said that before forcing doctors to decide who lives and who dies, hospitals and governments must work to increase the efficiency of the fractured American health system.

They could free beds by postponing certain surgeries, share transportation, allow doctors to cross state lines, and exercise anywhere in an emergency, waive patient treatment costs, and authorize hospitals for military and veterans to serve civilians.

 

“The least ethical thing to do is ration when it could be avoided by having had better exchange and cooperation between the institutions,” Caplan said.

The public can also prepare. Anyone who feels strongly that they would choose to sacrifice for a younger person, or with fewer health complications, could update their advance health care directive now before it is too late. “It’s one of the things that hasn’t really been talked about,” Wynia said. “If someone would rather say, ‘Take care of the young man, I’m fine,’ they should say it now, while they can still speak.”

The Challenges Of Health Personnel In The Face of The COVID-19 Pandemic

Health personnel is all persons involved in activities to improve health and include those who provide the services (doctors, nurses, midwives, dentists, community workers, and social workers, laboratory personnel, cabinet, pharmacists, auxiliary personnel). Those who direct and organize the operation of the health system as managers, administrators, or directors are also included.

The work of health personnel is more than direct care for COVID-19 patients. Their tasks also consist of caring for the health of the population through education, prevention, and promotion activities; In addition, they carry out tasks such as identifying cases, look for their contacts, take and analyze diagnostic tests, among other activities in addition to their daily work, both in clinics and hospitals and in the community.

From the beginning, health personnel has been as the first line of care, exposed to extreme circumstances to carry out their work, at increased risk of infection, long working hours, in many cases without the appropriate team and facing anguish, fatigue, occupational exhaustion, uncertainty, ethical dilemmas and unusually, stigma, which manifests itself in physical and psychological violence by the population.

The region is short of health personnel, and in the face of the pandemic, this need has been exacerbated. The speed in the increase in the number of patients triggered urgent measures to balance the capacity to offer services. The insufficiency of health personnel has been tangible, not only in terms of quantity but also of their competencies.

Ethical dilemmas

As a consequence of the precariousness of the infrastructure, the COVID-19 pandemic has accentuated important ethical dilemmas. The imbalance between supply and demand for health services was exacerbated due to the rapid increase in the number of critically ill patients. The ethical dilemma of doctors is evident when having to make the decision that patients should be screened, treated, or prioritized in a context of scarcity; for example, if they lack the indispensable beds or fans for the number of patients, it is necessary to decide who to see. The extreme circumstances of the pandemic place doctors in situations beyond their control and for which decision-making requires a solid ethical foundation.

Paranoia

Fear of the unknown has generated aggressive and discriminatory behavior towards health professionals. Society requires clear, precise, and understandable information about the importance and value of health personnel in the face of the pandemic.

The Importance Of Research In Hospitals

The research work of a hospital is one of the tools that best identifies its excellence. It has always been like this, but in weeks like this, it is highlighted because the results are palpable. That is precisely the double-edged sword that falls on all investigative tasks when efforts fail, something that is natural in science but is not always understood. Neither the times nor the results are accommodated for a society that is installed in the rush and fashion. That is why it is fair that when you reach a good port, you recognize yourself and shout to the four winds.

This week the National Health System can boast that two investigations are going to improve the quality of life of thousands of patients. This is something that all of society should be proud of, without underestimating other benefits of the country. Both have been born from an effort of more than twenty years and with the vanguard by the flag because we are talking about cellular therapies whose successful result today began with the doubts that accompanied stem cells in their beginnings.

But in addition, the experiences also tell us about the importance of public-private collaboration. On many occasions, this binomial is misinterpreted because it is understood —and wrongly— that it is an intrusion of the private into the public. Nothing is further from reality. Without Takeda’s contribution, the first allogeneic therapy approved in Spain would not be news today because there would have been no financial resources to support the laborious and expensive research tasks. But it is that for NC1, approved in the Inter-territorial Council, and in the absence of a price that will not belong incoming, the story is very similar. In this case, there has not been a pharmaceutical company that commercializes it due to the intrinsic difficulties that the administration of the therapy entails with cells of the patient himself,

The moral of these stories is that tenacity is a necessary quality in research, but it is not enough. For the medicine to come to fruition, there must be financing, and if it is carried out under-regulated legal contracts, it is never bad for that money to come from someone who has the sensibility or the vision that researchers have an improvement for everyone.