The BMA has issued FAQ guidance on decisions concerning the withholding and withdrawal of treatment in the context of COVID-19: https://beta.bma.org.uk/media/2219/bma-covid-19-long-form-faqs.pdf

Brief thread.

#Ethics #bioethics #profesionalethics #medicalethics #medicallaw #coronavirusuk #COVID19

First thing: the BMA holds that it is possible to prioritise candidates for potentially life-saving treatment, and that - as a matter of ethics, and as a matter of law - it would be permissible to choose to divert limited resources to those with a lower priority.

So what's the basis for differentiating? For the BMA, it's "capacity to benefit quickly".

Bluntly, it's getting the most bang for your buck.

And this means refusing some people treatment.

(As it happens, the language of thresholds strikes me as suboptimal here: taken out of context, that makes it look a bit absolutist, as though if there were lots of spare ventilators, someone might still be refused. Context is important.)

The rules attract a qualifier, too:

This is important: the BMA holds (not unreasonably, I think) that there is no distinction between withholding treatment and withdrawing it.

And this, too, is important. Decisions not to treat are *not* best interest decisions, and so best interest criteria are moot. As @TorButlerCole says, they're public law decisions.

There's some nifty jurisprudential and moral footwork on the discrimination problem.

Bluntly: if we're deprioritising someone because they're less likely to benefit from treatment, isn't that indirect discrimination (eg on the basis of age/ comorbidity, since the elderly and ->

preexisting conditions are less likely to benefit)? And, as such, wouldn't it be unlawful as well as ethically fraught?

Here, the BMA makes a smart move. Yes, it would be indirect discrimination. But the (im)permissibility of that is a further question. The BMA thinks it permissible.

I think that this must be right. The NHS discriminates all the time. If you're not ill, you don't get the same amount spent on you. Men don't get cervical smears; women don't get prostate checks. They're discriminatory policies, but not unjust.

The question is not "Is this discriminatory?", but "Is this discrimination just?".

Methodologically, the BMA is doing the right thing.

I think that they're probably coming up with decent answers, too. (Some may dispute those answers: but they surely must be taken seriously.)

This point isn't a reference to the Equalities Act; it's a wider point about justice. But the EA allows for that moral argument to be made within the law.

Final bit: The BMA is also concerned for the welfare of members. As a trade union, that's what it's for, after all. And so it thinks that there may be circumstances when medical staff could refuse to treat out of concern for their own welfare.

Again: this has to be correct. We may think that doctors are doing an unusually important job, but it is at the end of the day just a job. They're under no more obligation than anyone else to put themselves at risk, even if they do do that as a matter of fact.

The final sentence is bang-on.

Sure: doctors have responsibilities to their patients. But they also have other responsibilities - notably, to themselves.