With few resources, no respirators, and no intensive care unit beds, doctors are forced to decide who lives and who dies.
The Spanish Society of Critical Intensive Medicine and Coronary Units (Semicyuc) published a few days ago a guide to help doctors prioritize patients. Among the recommendations; it was advised not to intubate people over 80 years of age or people with Alzheimer’s and neurodegenerative diseases, and “social value” of the patients.
In response to these recommendations, the Spanish Bioethics Committee made a report with common criteria for all hospitals, which corrects the orientation of the intensivists.
This government advisory body rejects that age and disability are exclusive criteria for deciding to whom the maximum therapeutic effort is dedicated. “It is necessary to assess the specific circumstances of each patient, without excluding anyone a priori. The disability of the sick person cannot itself be a reason to rule them out, “they point out.
The institution understands the need to prioritize resources. But he cautions that rationalization can never be applied automatically, “Every human being has the right to personal consideration,” write bioethicists who sign the document.
Every human being is socially useful
The committee is concerned that health experts reject other patients with pathologies different to coronavirus. Besides that, the commitee rejects the utilitarian concept of “social value” that the Spanish Society of Intensive Medicine uses.
“Every human being by the mere fact of being human is socially useful, considering the ontological value of dignity,” they write.
This commitee understands the criteria based on the patient’s ability to recover, but asks that contrary prejudices towards the elderly or disabled be eliminated. “The term social utility seems extremely ambiguous and ethically debatable to us,” write the experts of the Bioethics Committee.
They believe that it would be unfair that the people whose health is most threatened by an eventual spread of the coronavirus were, in turn, the most affected by the crisis in the health system.
The person’s disability cannot be a reason for rejection
The criteria of the document of the ICU specialists advised to select the patients according to the years and capacity to live without disability above the isolated survival. Or that patients with cognitive impairment, dementia or other degenerative diseases, did not benefit from mechanical ventilation systems.
The Bioethics Committee states that this idea is not compatible with the International Convention on the Rights of Persons with Disabilities, a treaty signed and ratified by Spain. “In light of these precepts, it is clear that the disability of the sick person can never in itself be a reason that prioritizes the care of those without disabilities.”
The age criterion can only be used to prioritize, but not to deny or limit medical assistance and the use of certain life support measures. Undoubtedly, age, like other circumstances, can influence the clinical prognosis, but in no case, they caan ignore it.