Sunday 22 March 2020
The day-to-day task of doctors in the hospital’s resuscitation department lies, whether in light of the spread of the new epidemic of Corona or before, the choice among patients who will be placed on respirators. But the current epidemic will force them to “screen” patients widely, which raises ethical questions.
The Covid-19 epidemic has killed more than 13,000 people in the world and infected more than 300,000, according to official figures recorded.
And in dangerous conditions, patients need refreshment that overburdens hospitals and overpowers them in some countries. But in these circumstances, which patient should benefit from the ventilator?
Resuscitation doctors confirm that there have been guidelines for good practices for a long time.
“We are not starting from scratch,” said Bertrand Gedet, head of the intensive care and recovery department at Saint Antoine Hospital in Paris. “We are decisions that we make every day.”
He explains that in order to make this decision, there are three evaluation criteria that also apply to people with the emerging coronavirus, which are “the patient’s desire”, “his general health condition” and “the seriousness of his illness”.
Regarding the patient’s desire, doctors invite families to discuss the matter beforehand, because the recovery is “very heavy” for people with Covid-19 virus in severe cases with potentially severe consequences if they survive the disease, especially the most vulnerable.
And the doctor explains, “You will find yourself over a period of three weeks with a machine that breathes and you asleep while their movement is paralyzed by narcotic drugs.”
Experts stress that whether or not there is a place, resuscitation may be “irrational”, noting that patients can only be directed to soothing pain.
But in the event of crises, such as earthquakes and assassinations, and of course the outbreak of the new Corona virus, the standards of resuscitation may be tightened as patients flow to limited equipment.
“Yes, we will have to give priority to (certain) patients. We take the expressions of (French) President Emmanuel Macron, we are at war, and the name is sorted along the lines of what happens on the battlefield where we leave seriously wounded because we think they will die,” Gedia says.
“At this moment, we are giving the respiratory system to the person with the greatest survival chances,” Dr. Philip DeVos, a resuscitation doctor in Liege, Belgium, told AFP.
“According to the available means, we will try to make it not like withdrawing a lottery,” he said, referring to a set of criteria such as the age of the injured and the diseases he is already suffering from.
At a time when the number of injured people is doubling, he must also, according to Ghaideh, “stand the long-term.” He explains that “patients who now come should not be given priority over those who arrive in a week or 15 days, all means should not be exhausted immediately.”
In Italy, which has become the country most affected by the disease, hospitals are overcrowded and doctors are doing their best.
Christian Salaroli, a resuscitation doctor at a hospital in Bergamo, told the Italian newspaper “Corriere della Sera” that “we cannot try to do wonders (…) we only try to save those who have a chance.” “We decide according to age and health status, as in all cases of war.”
In early March, given the state of the hospitals in Italy, the Italian Foundation for Anesthesiology, Reanimation and Intensive Care was planning to set the age for admission to care.
However, this is not unanimous. “Age alone, no,” said Dr. Gediah, noting that he was admitted to resuscitation with HIV-19 with a severe condition of 85 years, but that he did not suffer from any previous diseases and was still living independently until now. While there will be no place in the care of a forty-year-old person with cirrhosis in his final stage while still drinking alcohol.
These same principles apply to waiting lists for organ transplantation, according to Artur Kaplan of Grossman School of Medicine at New York University.
“There are people who have been dying every day for decades, because it is not possible to transplant organs for them,” an ethics biologist told AFP. “We do not have enough members (…) The system requires that we give (the member) to the person who has the most chance of survival,” he says.
But for people with new epidemics and despite the rules and recommendations, it is ultimately the responsible recovery doctor who will make the decision, sometimes during the night or urgently, alone or with a team, according to Kaplan.
“This is a huge moral burden,” said Dr. Davos. “We practice medicine to relieve people, not to choose who can live.”