Read on Twitter
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">https://beta.bma.org.uk/media/221... thread.
#Ethics #bioethics #profesionalethics #medicalethics #medicallaw #coronavirusuk #COVID19
Brief">https://beta.bma.org.uk/media/221... 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& #39;s the basis for differentiating? For the BMA, it& #39;s "capacity to benefit quickly".
Bluntly, it& #39;s getting the most bang for your buck.
Bluntly, it& #39;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& #39;re public law decisions.
There& #39;s some nifty jurisprudential and moral footwork on the discrimination problem.
Bluntly: if we& #39;re deprioritising someone because they& #39;re less likely to benefit from treatment, isn& #39;t that indirect discrimination (eg on the basis of age/ comorbidity, since the elderly and ->
Bluntly: if we& #39;re deprioritising someone because they& #39;re less likely to benefit from treatment, isn& #39;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& #39;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& #39;re not ill, you don& #39;t get the same amount spent on you. Men don& #39;t get cervical smears; women don& #39;t get prostate checks. They& #39;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& #39;re probably coming up with decent answers, too. (Some may dispute those answers: but they surely must be taken seriously.)
Methodologically, the BMA is doing the right thing.
I think that they& #39;re probably coming up with decent answers, too. (Some may dispute those answers: but they surely must be taken seriously.)
This point isn& #39;t a reference to the Equalities Act; it& #39;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& #39;s what it& #39;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& #39;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.
