“The guidance recommends the use of the clinical frailty score (CFS) as part of admission to hospital or to critical care … CFS should not be used in younger people.” Thus age is the first criterion used to determine whether a patient with COVID-19 will be given lifesaving treatment.
When is a patient ‘too old’ to receive lifesaving care?
Deciding who gets COVID-19 life-saving treatment
April 06, 2020
MedScape – In normal times, healthcare resources are allocated on the basis of need.
Those in most need of care go to the front of the queue. Clinicians are used to making difficult decisions about who gets which treatment – but these are not usual times.
The COVID-19 pandemic raises the spectre of doctors having to decide which equally critically-ill patients are offered potentially life-saving admission to intensive care, or ventilation, and which go without.
If all goes well and cases increase slowly enough to prevent the healthcare system from becoming overwhelmed, there may be sufficient equipment and care to go around.
But experience in Italy and Spain suggests that may not be the case. Previously unthinkable discussions need to take place now, to agree on how these decisions should be made. A different ethical framework is required.
Guidance
In 2007, the UK government produced national guidance for pandemic preparedness, which was updated in 2017. The guidance includes an ethical framework, which states: “Equal concern and respect is the fundamental principle.” Importantly, it says this means “everyone matters equally – but this does not mean that everyone is treated the same”.
Professional organisations including the British Medical Association (BMA) and Royal College of Physicians (RCP) have also put out guidance for their members.
The BMA guidance says:
“In dangerous pandemics the ethical balance of all doctors and health care workers must shift towards the utilitarian objective of equitable concern for all – while maintaining respect for all as ‘ends in themselves’.”
The RCP guidance, which is supported by many of the other royal colleges including the Royal College of General Practitioners and the Royal College of Nursing, says that fairness is the best way to understand the ethical problems that clinicians are likely to encounter.
“The principal values that inform this guidance are that any guidance should be accountable, inclusive, transparent, reasonable and responsive,” they write.
Why Do Doctors Need Guidance?
Anthony Wrigley, professor of ethics at Keele University, says:
“One of the most important things with having a clear set of guidelines is consistency… consistency is a vital component of justice [because] otherwise you’re not being fair – you are giving different responses and different outcomes potentially to people who are presenting with similar or the same levels of need or requests.”
Clarity is another key aspect, he says:
“For a system to be seen as just or fair people need to know the basis of it – how these decisions are being arrived at.”
People might disagree with the system, because there are many interpretations of what is just, but “what you want is to show you have a position and it is properly founded on entirely reasonable ethical principles”.
He said he had spoken to doctors preparing for decision making in the pandemic who “desperately want some assistance with this … ” Read more.
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