In an extremely informative session at the Euroanaesthesia 2020 this week, Caterina Aurilio of Naples, Italy, discussed triage in COVID-19 - who should be ventilated?
Prof. Aurilio highlighted the fact that guidelines had been developed by different health systems across the globe to provide treatments in the ICU and to reduce the burden on doctors who needed to determine which patients would get access to scarce resources. However, most of these recommendations have been controversial and have been criticised as being discriminatory to elderly patients and those with disabilities.
Prof. Aurilio talked about two ethical approaches: egalitarianism and utilitarianism. As per the concept of egalitarianism, every patient must be treated equally and should be treated as per their need. On the other hand, utilitarianism contends that treatment decisions should be based on the probability of success, length and quality of life.
She also pointed out during her presentation that current practice guidelines by the National Institute for Health and Care Excellence (NICE) are neither based on egalitarian nor utilitarian concepts. These guidelines are designed in a manner that they differentiate between people on the basis of their probability of survival and not on discrimination of age or disability. The NICE guidelines adopt an egalitarian approach when it comes to the provision of ventilators if a shortage occurred. At the same time, they use the utilitarian approach that treatment should be provided to those with the greatest chance of survival.
The NICE guidelines also state the critical care doctors are the primary decision-makers, but they should be guided in those decisions by ethical principles to ensure that these decisions achieve a balance between equality and utility. Care should be taken that critical care patients are not considered a mathematical choice but a moral choice.
Source: Prof. Aurilio Live Presentation #EA20
Image Credit: Prof. Aurilio @EA20