Covid-19 pandemic has produced disaster medicine conditions in many countries, including the UK. Disaster medicine refers to healthcare that is delivered in disaster situations such as war, pandemic, earthquake, ie. situations where need far outweighs resources.

We can and should be talking about criminal responsibility of all those who have wilfully ignored protests of doctors, nurses and patients going back 20 or more years, and continued to chronically underfund the NHS for personal gain.

Several elections have been fought over privatisations and the voters continued to enable those who promoted austerity and privatisation over funding public services and welfare. But none of this is important in the middle of the disaster.

This article here explores the realities of disaster medicine right now, in the NHS. I think it's a very good read https://www.theguardian.com/commentisfree/2020/mar/17/coronavirus-force-nhs-terrible-choices-covid19

It's been a long time since I went to medical school, so my younger colleagues can let us all know how things are done now, but during my training we had formal teaching in medical ethics. This included tutorials with a medical ethics professor, patients, lawyers and others.

Typically the format would involve a lecture/presentation of an aspect of medical ethics, followed by real life examples and discussions of real and fictional scenarios. All sorts of things were examined, from whether you would help Hitler if he was bleeding out in front of you

(Answer: yes, we are doctors not judge, jury and executioner) to who would you give a ventilator to if there were not enough ventilators (yes, really, that was quite a common scenario). Answer to that is much less straightforward.

What if you have an 80 year old and a 5 year old? What if 5 year old has a short life expectancy due to a condition and 80 year old is fit and healthy? What if 80 year old is a war criminal or a paedophile? What if you already gave a ventilator to Hitler, and now a 20 yo comes in

What about end of life care? Assisted dying? Prolonged life support? Brain death? Everyday, real-life conflicts between patient autonomy and best medical care. For example, what are ethics of medical decision making if patient is danger to themselves or others?

Or more mundane things such as when a patients refuses recommended treatment? What if by refusing they are risking a stroke or a heart attack? What if we are short of ICU and CCU beds at the time?

In my experience, medical discussions in general can be upsetting and discussions of medical ethics in disaster situations multiplies that upset, in laypeople as well as professionals. But medical professionals are trained to understand ethics and to make tough decisions.

The pandemic has plunged the entire society into an existential crisis. By that I mean we are all faced with our mortality, and have become acutely aware of how much we rely on the society which is full of flaws and injustices.

Capitalism is an extremely ableist ideology, and nowhere is that going to be more apparent than in the lives of vulnerable people. Whether you are sick, disabled, elderly, a minor, a member of an oppressed group, I understand your fears. I myself am disabled, as well as a doctor

And even though I see this issue from both sides, it makes no difference at the end of the day in me facing this crisis in my own body, which I cannot change. All I can do is hope that I survive. But I can vouch for something resembling pure altruism, and that is medical ethics.

People are fallible. But as doctors we have reflected on all the medical disasters of the past, Holocaust, forced sterilisations, lobotomies, genital mutilation, unethical experiments, wartime medicine, pandemics, every scenario that has so far arisen, has been learned from.

This is the best we can do. We don't have the luxury to practice "first come first served" medicine in a disaster, when the need far outweighs the resources. We can only be guided by our knowledge and duty and be prepared to be judged later, which we are.

I urge everyone to sit with their fear of not making the cut, and reflect on the job doctors have to do, when the number of UK patients who need ventilators outnumbers available ventilators.
Feel free to share how you would triage in this situation, and reasons for your decision