The resource, COVID-19 – ethical issues. A guidance note, which aims to support doctors on the ethical issues that are likely to arise when treating patients during the Covid-19 outbreak, comes as UK cases numbers rush past 33,000, with over 2,920 deaths, and the global number of confirmed cases now surpasses 1,000,000.
Around a quarter of these global cases have been reported in the US, and in a White House coronavirus task force press briefing on Sunday, Physician Dr Anthony Fauci asserted that it was possible that 100,000 to 200,000 people in the US will die from Covid-19.
In response, medical students in various countries have rushed to the aid, many now working on the frontline to help battle the ongoing pandemic. But, following these extreme developments, the BMA has issued new guidance to doctors practicing in the UK.
The BMA’s guidance covers topics such as resource allocation; triage; medical utility; liability issues; discrimination and equality legislation; and the impact on general practice.
“Given the lack of pre-existing immunity, it is likely that a considerable percentage of the population will seek, and may at some point require, medical attention. There is little or no surge capacity in the NHS although vigorous attempts are being made to reduce demand through social distancing and to increase the availability of intensive care beds,” the BMA’s guidance reads. “Nevertheless, it is possible that serious health needs may outstrip availability and difficult decisions will be required about how to distribute scarce lifesaving resources. Although we profoundly hope this will not be happen, it is important that we begin to think now about how we would respond should that situation arise in the future.”
Within the ethical framework section of the guidance, the BMA writes that some patients may be denied intensive forms of treatment that they would have received outside a pandemic and that health professionals may be obliged to withdraw treatment from some patients to enable treatment of others with a higher survival probability.
“Although doctors would likely find these decisions difficult, if there is radically reduced capacity to meet all serious health needs, it is both lawful and ethical for a doctor, following appropriate prioritisation policies, to refuse someone potentially life-saving treatment where someone else has a higher priority for the available treatment,” the guidance states. “These are grave decisions, but the legal principles were established in relation to the allocation of organs for transplantation and have been recently upheld by the Court of Appeal.”
Speaking on the new guidelines, Dr John Chisholm, Chairman of the BMA’s medical ethics committee, said: “Looking ahead to the coming weeks, if hard choices are required, we know they will be contested. There will be anger and pain.” He continued: “People who, in normal circumstances, would receive strenuous treatment may instead be given palliation in order to favour those with greater likelihood of benefiting. Nobody wants to make these decisions, but if resources are overwhelmed, these decisions must be made.”
Medical Ethicist and Barrister Daniel Sokol also commented on the new guidelines: “While the guidance highlights the ethical issues and dilemmas doctors will face, it will leave some puzzled and perhaps frustrated about how to apply the principles in practice. The guidance recognises that a challenge may be that large numbers of people requiring intensive care are likely to be equally suitable for it. But it doesn't give a clear answer to how doctors should select among this large group.”
In a less distresing update, the UK Government has announced that from the 1 April, over £13 billion of NHS debt will be scrapped as part of a new NHS funding model that has been initiated to ensure the NHS has the necessary funding and support to respond to the Covid-19 pandemic.
GOV.UK cites that 107 NHS trusts have an average of £100 million revenue debt each.
"As we tackle this crisis, nobody in our health service should be distracted by their hospital's past finances," said Matt Hancock, UK Health Secretary. "Today's £13.4-billion debt write-off will wipe the slate clean and allow NHS hospitals to plan for the future and invest in vital services."