Where Do You Sit On The Coronavirus Patient Priority List?

Health workers on the coronavirus frontline at Sydney hospitals have been given a set of ethical guidelines on how to prioritise Covid-19 patients during the crisis.

The ethical framework was put together by the Sydney Health Ethics committee at the University of Sydney and will be given to doctors to help them determine how to allocate scarce health resources.

According to the guidelines, hospitals are urged to form a committee which will be asked to make the big decisions so frontline staff, who are under immense pressure, don't have to.

“It also has the advantage of protecting those clinicians caring directly for patients from some of the direct stress and anxiety if they are the ones to be the decision makers about allocation,” the guidelines state.

"It is important gender, ethnicity, sexuality, disability, religious and political views are not used as the basis for deciding who gets care as this would be discriminatory."

When it comes to determining who would be allowed access to intensive care unit treatment should resources be running low, groups will be separated into high or low priority, based on how likely they are to recover.

Those who show promise would be given priority over those who are dying - for instance a person with terminal cancer would not be ventilated.

In terms of how to prioritise within the 'high priority' group, doctors and healthcare workers sit at the top of the list.

And when deciding between two cases of equal merit 'tie-breaker' considerations would be used.

“For example, clinicians who are ill with COVID-19 might receive priority as they could re-join the fight against COVID-19,” the guidelines said.

“Other possible groups we could choose to prioritise might include pregnant women or those with caring responsibilities for others."

They might also choose to prioritise patients from First Nations communities.

"Justification could be due to existing disadvantage, what we know of poorer outcomes for these groups from previous outbreaks, and some compensation for previous sustained injustice," the group said.

The team at Sydney Uni have noted these are only guidelines, not obligations, nor do they offer definitive solutions.

"Such a framework ‘frames’ decision-making – it does not list or stipulate general answers. Much will be left to expert judgment in response to different circumstances as they arise," the paper reads.

Resource allocation is vital because when supply cannot meet demand, staff must decide how to distribute it.

For instance, essential resources during the coronavirus pandemic include intensive care beds, ventilators, clinical expertise, personal protective equipment (PPE), diagnostics, medications, and vaccines.

"Resource allocation decisions will always be controversial. However, we can agree on a process for reaching decisions, even if we disagree on which ethical considerations we should use," the guidelines state.

Length and quality of life after hospital treatment will be relevant in decision making, the committee added.

The guidelines warn doctors not to act like heroes and to take proper precatuions when treating Covid-19 patients.

"Clinicians should avoid 'heroic' or 'sacrificial' actions that are likely to take them out of the health care system," it said.

It is believed the request to develop a set of ethical guidelines was driven by concerns the intensive care units will be overwhelmed by Covid-19 patients.