Ethical considerations relating to critical care in the context of COVID-19

On Friday 3 April, the National Public Health Emergency Team (NPHET) approved the guidance document “Ethical considerations relating to critical care in the context of COVID-19”.

This guidance is directed at clinical staff who may be involved in making decisions regarding the prioritisation of critical care resources in the context of COVID-19.

The Department of Health has been working intensively with the HSE during the last month to significantly increase the critical care capacity within the hospital system.

The extensive measures introduced in recent weeks aim to “flatten the curve” and ensure that hospitals will have the necessary resources to treat those who require hospitalisation as a result of COVID-19.

Every day, clinicians in our hospitals use their clinical judgment in deciding which patients will benefit from intensive care treatment. COVID-19 is associated with acute respiratory illness, and some patients will require respiratory support (for example, oxygen, ventilation and so on) and admission for intensive care treatment.

If the number of cases continues to increase, critical care resources may come under strain, which underscores the importance of adhering to public health measures and advice. In such a scenario, there is a duty to use limited resources prudently and fairly to minimise the loss of life and suffering and produce the maximum benefit possible for individuals served by those interventions.

This guidance aims to support clinicians working in a demanding and complex environment, in continuing to use good clinical judgment in coming to decisions regarding which patients will benefit most from critical care interventions. The starting point, as always, for such decisions is that every life matters; everyone will receive care.

It is essential that clinicians discuss the possible risks and benefits associated with intensive care with patients (where possible) and their families in advance of, or upon admission to the ICU. Not all patients will wish to be ventilated in an intensive care unit.

Access to intensive care should generally be reserved for those patients most likely to benefit (those who will most likely survive their acute illness with reasonable long-term functional status). No single factor (e.g. a person’s age) should be taken, in isolation, as a determining factor and decisions should not be made arbitrarily or in such a way as to result in unfair discrimination.

Where it is decided that the provision of intensive care treatment is not beneficial or possible in light of the circumstances, patients will be provided with other available and potentially beneficial forms of treatment.