Ethical and clinical issues in the provision of medical care during the covid-19 pandemic in Colombia: A global perspective for a contribution in the local context

Abstract

The COVID-19 pandemic has created many challenges, particularly for health systems, which may be forced to ration the resources available to treat patients with this disease. This decision, with its ethical connotation, forces health care institutions to choose, among patients with similar vital needs, who will receive the scarce available life support resources in the emergency or intensive care units based on prognostic criteria. This utilitarian approach strives to achieve the greatest benefit for largest possible number of patients; however, in Colombia, its implementation faces several obstacles, such as the medical ethos, the instruments used to define the prognosis, the criteria for prioritization, the legal-constitutional precepts, and the economic nature of the provision of intensive care in the country. The objective of this article is to reflect on these aspects and propose an approach model for patient prioritization based on the creation of multidisciplinary teams that make decisions within a transparent, humane, plural, impartial, equitable and fair methodological framework. In the context of the current pandemic, these multidisciplinary teams should be guided by four ethical-clinical principles: (a) treating all persons equally, (b) prioritizing patients with the worst condition, (c) maximizing the benefits that can be obtained from the scarce resources available, and (d) preferably selecting patients with instrumental value. If these four principles are followed, the guidelines drawn up by the Colombian Government with respect to the care of COVID-19 patients would be fulfilled within a context of ethical medical autonomy, as well as within scientific and professional practice determined by a utilitarian perspective.