■ Duties and responsibilities:
Expectations of physicians in practice
Navigating ethical frameworks and critical care resource allocation protocols amid COVID-19
Published: June 2020
The information in this article was correct at the time of publishing
- Ethical decision-making frameworks are intended to assist in decisions on allocating resources among COVID-19 infected patients in an ethically informed manner. This is often achieved by way of protocols for allocation of critical care resources.
- Deciding which patients receive critical care resources during the COVID-19 pandemic can create significant clinical uncertainty, as well as ethical and moral distress.
- Critical care resource allocation protocols can conflict with the duty of care to individual patients and potentially create medical-legal risk.
The bottom line
- Critical care resource allocation protocols are used as a last resort and do not extend beyond the COVID-19 public health emergency.
- These protocols intentionally focus on a broader set of considerations, rather than the rights of individual patients.
- Contact the CMPA for context-specific advice regarding your medical-legal risks associated with a particular resource allocation protocol.
Need to know
How do critical care resource allocation protocols help me?
- Resource allocation protocols can provide objectivity, consistency, and efficiency for decisions regarding the management of critical care resources. They provide guidance for determining which patients receive treatment, the level of care, and under what circumstances.
- Triage officers, teams, or committees tasked with implementing resource allocation protocols can alleviate some of the individual moral burden, allowing you to better focus on providing the best possible care to patients.
How are my obligations different under resource allocation protocols?
- Be aware that resource allocation protocols focus on maximizing benefits for the public at large and may override the duty of care to individual patients.
- Follow any applicable and relevant resource allocation protocols established by your healthcare institution, health authority, public health agency, or government. In some jurisdictions, such protocols have the force of law if ordered under emergency management legislation.
- Thoroughly document your understanding of the resource allocation protocols being applied, as well as your rationale for deviating from or deciding not to apply an established protocol if this is necessary for a specific patient.
- Proactively communicate with patients, substitute-decisions makers, and families (where appropriate) how resource allocation protocols might affect patient care and how they might impact the application of any advance care directives and other end-of-life wishes.
- Apply resource allocation protocols fairly and consistently across all patients with similar prognoses. While the primary purpose is to prioritize certain patients over others, patients cannot be discriminated against based on a prohibited ground of discrimination.
Does following an ethical framework create liability?
- Withdrawing a critical care resource from a patient without consent would normally create a risk of civil liability, criminal liability, and/or professional discipline. Resource allocation protocols require these unilateral decisions.
- Governments and regulatory authorities (Colleges) can undertake various legislative, administrative, and policy initiatives to protect physicians and other healthcare providers from liability and professional discipline for applying established resource allocation protocols and responding to the unique challenges that COVID-19 presents.
- Courts and Colleges would generally take into account an accepted resource allocation protocol, if there is an allegation that a critical care resource was removed from a patient without a conclusion that treatment is futile and without the consent of the patient or their substitute decision-maker.
- Failing to follow an established resource allocation protocol could also lead to civil liability, criminal liability, or professional discipline.
- If there is a surge in COVID-19 patients such that resources are close to depletion, critical care resource allocation protocols will apply to all patients, including those with other medical conditions who may require the same resources as those patients infected with COVID-19.
- Ethical frameworks developed in response to COVID-19 may continue to influence the management of resources, even once COVID-19 subsides.
- Resource allocation protocols may also be developed to assist in managing wait lists and a backlog of non-essential medical services.
- Resource allocation protocols and ethical frameworks: