It is unethical to use universal do-not-resuscitate orders, social worth, and life-years to decide who receives scarce healthcare resources during the COVID-19 pandemic or other catastrophes, according to a leading physician group.
“Today’s coronavirus pandemic is novel, but the ethical dilemmas it presents are not,” asserts the American College of Physicians in a recent opinion piece. “Resource allocation approaches that advocate disadvantaging older adults, disabled persons, or other groups on the basis of diagnosis, perceived social worth, or predicted life expectancy send a message to all patients that some lives are valued more than others,” write Thomas A. Bledsoe, M.D., and colleagues.
“This will engender distrust in the medical profession — now, when trust is most needed, as well as into the future.”
While crisis triage may become necessary during extreme health events, “prioritization does not mean discrimination against groups,” the association explained. For example, applying a DNR policy to all patients with COVID-19 is problematic, the group contends.
“For some patients (with or without COVID-19), the likelihood of harm is so high and that of benefit so low that resuscitation is not clinically indicated. A blanket approach, however, is not consistent with an individualized, evidence-based, clinical assessment,” the authors stated.
“Fairness will not tolerate judgments about worthiness or ask physicians to make quality-of-life assessments,” they conclude.
The full opinion piece was published Friday in the Annals of Internal Medicine.
