With the increasing number of COVID-19 cases in the country, a study from the University of the Philippines Manila predicts that the worst case scenario for the healthcare system is the surge of patients exceeding available healthcare resources to the extent that “critical care may have to be rationed.” This brings about issues on the standard of care provided to patients leading to ethical implications. To address this, a research team led by Mr. Peter Sy of the University of the Philippines Manila came out with the “Ethics Guidelines on COVID-19 Crisis-Level Hospital Care,” a document healthcare providers may adapt and adjust according to their institution’s needs during the pandemic.
Last April 13, 2020, the University of the Philippines Manila held an online conference which served as a venue for the project team and healthcare stakeholders to discuss the guidelines, how it can help the healthcare providers, and what improvements can be made to the document.
Dr. Belle Siasoco, a co-investigator of the project, cited five ethical elements considered in the creation of the guidelines, namely procedural fairness, urgency, duty to care, equity, and to minimize harm. The document aims to help healthcare providers answer the question, “How should decision-makers balance between saving as many lives as possible or relieving as much pain and suffering as possible, on the one hand, and, on the other, aiming for the best possible quality of life as well as as seeing through the cases of patients they have come to care for?”
The “Ethics Guidelines on COVID-19 Crisis-Level Hospital Care” contains the following sections:
● Principles- Elaborates the ethical elements in which the rest of the document is based from.
● Admission triage- Provides guidelines on patient admission and the type of care to be provided to the patient
● Communication of care- Focuses on ensuring communication of care to the patients’ families
● Therapeutic interventions- Provides guidelines on the use of available alternative therapeutic interventions for treatment
● ICU allocation- Provides guidelines on patient admission to the ICU and its processes
● Care for non-COVID-19 patients- Provides guidelines on providing care for non-COVID-19 patients
● Information management- Elaborates on the information healthcare providers may attain and discloses
● Research- Provides guidelines on conducting research in time of the pandemic
● Personnel rights and obligations- Provides guidelines on healthcare worker rights and obligations
● Working committees- Elaborates tasks of committees within hospitals and the establishment of the patient liaison committee
● Post mortem care- Provides guidelines on post-mortem care of suspected and confirmed COVID-19 case
Some features of the document include the establishment of the patient liaison committee and provision of alternatives such as palliative care to the patients. The patient liaison committee will be the authorized body to decide “on withholding or withdrawing ventilator support for any given case, based primarily on the criteria-based assessments of the attending physicians.” Once a patient cannot be provided ventilator support according to the criteria set by the committee, the patient may opt for palliative care. It was also pointed out that engagement with the family of the patient must also be a priority for crisis-level healthcare.
The document will undergo further revisions based on the discussion during the recent online conference. To read the latest version of the guidelines, visit this link: http://ethicists.org/
To watch a replay of the online conference, click here: https://www.youtube.com/