English bishops urge a ‘criteria of fairness’ when assessing care for COVID-19 patients

English bishops urge a ‘criteria of fairness’ when assessing care for COVID-19 patients

A worker paints a fence built over recent days to block the view of the ambulance entrance area outside St Thomas' Hospital in central London, April 9, 2020. (Credit: Kirsty Wigglesworth/AP.)

Human value is not a measure of “our mental or physical capacity, our societal function, our age, our health or of any other qualitative assessment,” said the Catholic Bishops’ Conference of England and Wales in a statement about accessing healthcare during the COVID-19 coronavirus pandemic.

LEICESTER, United Kingdom – Human value is not a measure of “our mental or physical capacity, our societal function, our age, our health or of any other qualitative assessment,” said the Catholic Bishops’ Conference of England and Wales in a statement about accessing healthcare during the COVID-19 coronavirus pandemic.

According to figures released Monday evening, 16,509 people with COVID-19 have died in British hospitals, although that figure doesn’t include those who died in nursing homes and other care facilities. So far 124,743 people in the country have tested positive for the coronavirus that causes COVID-19.

To handle the surge in patients, the UK’s National Health Service – which is a nationalized healthcare system – has established seven “Nightingale hospitals” in places such as arenas to provide additional intensive care beds.

However, there is concern of a triage situation developing, and the UK’s National Institute for Health and Care Excellence has established guidelines for assessing patients which includes use of a Clinical Frailty Scale which gives an indication of the likelihood of a patient surviving treatment.

“With the escalation of the Coronavirus, demand on NHS resources is outstripping supply and those responsible for our care and well-being are facing challenging decisions,” the bishops’ statement said.

It was signed by Bishop Richard Moth, Bishop Paul Mason, and Bishop John Sherrington – the conference’s lead bishops for Social Justice, Healthcare and Mental Health, and Life Issues.

“What may well be on all of our minds is what provision will be available if I, or a loved one, is in need of treatment and life-support in these circumstances. While we would all agree that the allocation of resources must be done as fairly as possible, the criteria of fairness must be clear and shared by us all. These principles apply both morally and in the law which governs our expectations and rights on health and social care,” the statement said.

“A decision against offering a certain life-prolonging treatment to an individual must never be a judgement based on the worthwhileness of that person’s life, including their age or other social characteristics, but a pragmatic decision about the likelihood of him/her benefiting from the intervention given their medical condition. This principle has been upheld in case law repeatedly and the NHS Constitution itself is clear that we should deliver care and support in a way that achieves dignity and compassion for each and every person we serve,” the bishops continued.

The bishops said people with underlying health conditions should discuss the sort of treatment they may want with their families so that good communication is possible in a crisis.

“Each of us may be presented with clinical scenarios which are both unwelcome and distressing, yet doctors are faced with making the least-worst decisions. This approach helps us to focus on the common good. Similarly, Catholics will focus on the benefit of a particular treatment for the person taking into consideration all medical factors. This, again, helps us to focus on the common good of all and best meets the principles of justice and equality,” the statement continued.

The bishops were alluding to the use of ventilators – often necessary in severe cases of COVID-19 – which can often be traumatic for the patient, and lead to other complications.

“Clear communication with the sick and their loved ones is essential throughout this process, and medical staff will need to deal sensitively with those affected,” they said.

The bishops’ statement was welcomed by Michael Wee, the Education and Research Officer at the Oxford-based Anscombe Bioethics Centre, a Catholic academic institute.

“Sadly, there are situations where it is impossible to treat everyone,” he told Crux.

“If doctors have to choose between patients, then prioritizing those most likely to benefit clinically from treatment among those who require critical care is a fair approach. This is in order to maximize the benefit that can be achieved through the limited resources available. It is not the same as deciding whose life is more worth saving, and it should certainly not be viewed by either patients or doctors as a backdoor to euthanasia,” Wee explained.

Anscombe recently published a briefing paper on the Catholic ethical principles of resource allegation in relation to the pandemic.

The paper said the key principle of justice in healthcare allocation is that healthcare should be distributed in accordance to need, but if there are not enough resources to treat all urgent cases then it is also reasonable and not unjust to favor a patient who is more likely to benefit.

“There are challenges in applying the criterion of clinical benefit to concrete situations. Over-reliance on frailty scoring systems or on decision-making algorithms, especially in times of high pressure, can lead to the neglect of holistic, individualized assessment,” Wee said.

He expressed concern over reports that some healthcare institutions are encouraging patients with certain conditions to “self-triage” by signing a “Do Not Attempt CPR” form.

“These are ways in which discriminatory attitudes against age or disability can supplant proper clinical judgement about likely benefit. A ‘tick box’ approach to assessment or triage does not serve the dignity of the human person,” Wee told Crux. He also noted the NHS has reminded hospitals that “blanket policies” in relation to age, disability or condition are not appropriate.

“At the end of the day, one cannot deny the tragic reality that those who are more vulnerable in the face of the coronavirus are also those less likely to receive treatment when there is great scarcity of resources,” he said. “This is why it is important for doctors to reassure all patients that they are never abandoned. Even when treatment cannot be made available, the medical team must make provisions for palliative care where it is needed.”

Wee suggested that videoconferencing or the discretionary issuing of protective equipment to close family or chaplains “can be important means of ensuring that those who are dying receive the emotional and spiritual support they need.”

“While it is understandable that many resources are being diverted to help treat those who have been infected, care of the dying must also be a priority area in resource allocation,” he argued.

Follow Charles Collins on Twitter: @CharlesinRome

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