The ethical implications of coronavirus. Who gets the bed in ICU?

Mar 20, 2020
It's an ethical issue that is becoming increasingly important to consider. Source: Getty

As the world continues to hold its breath in the wake of coronavirus, every day we’re bombarded with news of the pandemics trajectory and the subsequent fallout.

At the time of publishing, the global number of cases stands at 245,033, isolation laws have been enforced, entire sectors are grappling with a failing economy, planes have been grounded and borders closed. Toilet paper and hand sanitizer have become hot commodity, rarely seen on supermarket shelves, while airlines lay off staff and travel and wedding plans are cancelled the world over.

And while the ramifications of the virus are likely to continue for some time, it puts the spotlight on a particularly important issue affecting the health industry. As cases continue to rise and outnumber our already-overwhelmed Intensive Care Unit’s (ICU) and medical staff, who gets priority when it comes to receiving life-saving care?

It’s an ethical issue that is becoming increasingly important to consider, as the virus impacts both young, able-bodied individuals and older people with pre-existing conditions and lower immune systems.

It comes down to the fact that if a 40-year-old present with coronavirus-symptoms and requires a ventilator, at the same time as an 80-year-old, should the life of the 40-year-old be prioritised, given they have a longer life span to live, and better chance of survival? They would likely recover quicker, requiring less time in the ICU or on ventilation, freeing up beds for other patients faster than older people who might take weeks or months to recover, if at all.

In Italy, which has currently the epicentre of the virus, having recently overtaken China with the most deaths recorded, guidelines have surfaced which reveal how they are addressing the issue.

The document states: “The criteria for access to intensive therapy in cases of emergency must include age of less than 80 or a score on the Charlson Comorbidity Index [which indicates how many other medical conditions the patient has] of less than five”.

Likewise, doctors in Niguarda are reportedly declining life-prolonging treatment to patients over the age of 60.

Here in Australia, there is currently no formal proceedings around the matter, though it’s something that health professionals continue to weigh in on. Australia currently has roughly 2,500 ICU beds, so if predictions for the pandemic’s effect on the nation are true — NSW chief medical officer Dr Kerry Chant estimates that around 5 million Aussies could get the virus — then it will mean a tough call for medical staff.

Professor Paul Komesaroff from Monash University shed some light on how things will unfold on local soil.

“There are limited facilities in the high-tech areas such as intensive care and the ability to ventilate patients,” he told the Daily Mail Australia. “There is a very serious possibility a sudden increase in people requiring ventilation would overwhelm the system.”

As for how doctors will decide who will get first access to ICU beds and life-saving ventilation, Professor Komesaroff said that this is not unchartered territory.

“Decisions based on triage are common practice in medicine,” he said. “Doctors choose patients who are most likely to achieve a favourable outcome. The focus is on the individual and the ability of medical intervention.

“The doctor examines carefully a person’s total medical need and the ability of the proposed intervention to make a difference. It’s a difficult conversation with no absolutely clear, correct decision.”

Important information: The information provided on this website is of a general nature and information purposes only. It does not take into account your personal health requirements or existing medical conditions. It is not personalised health advice and must not be relied upon as such. Before making any decisions about your health or changes to medication, diet and exercise routines you should determine whether the information is appropriate in terms of your particular circumstances and seek advice from a medical professional.

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