A researcher from The University of Western Australia has highlighted the ethical choices faced by healthcare professionals as they decide who is allocated scarce life-saving medical resources during the COVID-19 crisis.
The experience of COVID-19 has revealed an undersupply of key medical and protective equipment in even the most advanced economies.
But the prospect of having to make the sort of life and death decisions around the administration of life-saving treatment for this virus goes to the heart of medical ethics and the core duties of health professionals.
When the global pandemic produced scenes of exhausted health-care workers and the shocking number of daily deaths, one of the more disturbing reports was evidence from doctors having to choose who would receive ventilation treatment.
Ventilation is a life-saving treatment that facilitates or even replaces respiratory function, where the patient’s body cannot perform this.
Associate Professor Meredith Blake from the UWA Law School is researching the medical end-of-life ethics involved in deciding who gets life-saving treatment, such as ventilation and intensive care beds, and who does not.
Professor Blake said there were distinct ethical theories that supported a morally acceptable answer to this question.
“The first group of theories is concerned with the duties humans owe each other, assessing the morality of an action or inaction based on whether our treatment of others is consistent with these duties,” Professor Blake said.
“Within this approach, the duty to respect the sanctity of life means that every person’s life is regarded as equally valuable.”
“As a result, all would be entitled to receive the life-saving treatment and where the treatment is not available, it equates to the equivalent of waiting in a queue.”
A second group of theories is based on the consideration of the consequences of an action or decision.
The most well known of these theories advocates for doing the greatest good for the greatest number.
This has implications when it is used to assess the net saving of lives.
Professor Blake said such an approach would prioritise ventilator access to those most likely to survive as a result of the treatment and who were likely to require less time on ventilators.
“These judgements are based on an assessment of a person’s quality of life, potentially marginalising the already vulnerable members of our society, such as those living with disabilities and many elderly people,” Professor Blake said.
“The problem is that we have our own subjective views of what makes a ‘good life’ and a health care allocation system could exclude those who don’t conform to what might be an uninformed perception of another’s quality of life.”
A more commonly used ethical approach is one that seeks to balance four key ethical principles (autonomy, justice, beneficence and non-maleficence) as the basis for a morally acceptable outcome.
Professor Blake said that there were challenges associated with this approach, further complicated by our lack of knowledge about the basis of individual responses to the virus.
“One challenge is balancing the principles in cases where they appear to conflict, for example where there is evidence that a scarce treatment resource can be highly effective, and there is a sudden high demand for that resource,” Professor Blake said.
“While we do have ethical theories that can lead to a consistent application of moral standards in making these difficult decisions, we might not like the implications of these.”