COVID-19: when health care resources run short, how to pick who should (not) get treated?

INTRODUCTION: Almost a year and a half after its appearance, Covid-19 continues to make painful triage choices necessary in granting access intensive care. OBJECTIVE: the article aims to illustrate the difference between the utilitarian-collectivist approach and the deontologic approach, which inspired the guidelines drawn up in Italy in 2021 by SIAARTI in collaboration with SIMLA. MATERIALS AND METHODS: the article draws upon international scientific sources and documents from ethics committees and scientific societies on triage for Covid-19 patients in intensive care. RESULTS: only medical parameters should be evaluated to establish the prognosis through which to identify the patients to be treated as a priority. If non-medical standards are taken into account, such as patient age, discrimination is likely to arise, and the patient’s interest is somehow subordinated to that of the community. DISCUSSION: it is not part of the doctor’s duty to exclude patients from intensive care in order to grant access to treatment to those most likely to survive. Guaranteeing treatment availability for as many patients as possible is the duty of national and local health policy managers, and cannot be deemed to be the doctors’ responsibility. CONCLUSION: moral judgment cannot concern only the choices of doctors. According to the principle of beneficence, hospital directors and national and local health policy managers must also take action, in particular to eliminate waste of economic resources so as to allocate more of them to health protection, especially in consideration of the predictability with which infection rates increase, and in light of the fact that immunization through vaccination is only temporary. (www.actabiomedica.it)