[Ethical recommendations for a difficult decision-making in intensive care units due to the exceptional situation of crisis by the COVID-19 pandemia: A rapid review & consensus of experts]

Med Intensiva. 2020 Oct;44(7):439-445. doi: 10.1016/j.medin.2020.04.006. Epub 2020 Apr 15.
[Article in Spanish]

Abstract

In view of the exceptional public health situation caused by the COVID-19 pandemic, a consensus work has been promoted from the ethics group of the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC), with the objective of finding some answers from ethics to the crossroads between the increase of people with intensive care needs and the effective availability of means.In a very short period, the medical practice framework has been changed to a 'catastrophe medicine' scenario, with the consequent change in the decision-making parameters. In this context, the allocation of resources or the prioritization of treatment become crucial elements, and it is important to have an ethical reference framework to be able to make the necessary clinical decisions. For this, a process of narrative review of the evidence has been carried out, followed by a unsystematic consensus of experts, which has resulted in both the publication of a position paper and recommendations from SEMICYUC itself, and the consensus between 18 scientific societies and 5 institutes/chairs of bioethics and palliative care of a framework document of reference for general ethical recommendations in this context of crisis.

Ante la situación excepcional de salud pública provocada por la pandemia por COVID-19, desde el grupo de ética de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) se ha promovido un trabajo de consenso con el objetivo de encontrar algunas respuestas desde la ética a la encrucijada entre el incremento de personas con necesidades de atención intensiva y la disponibilidad efectiva de medios.

En un periodo muy corto de tiempo se ha cambiado el marco de ejercicio de la medicina hacia un escenario de «medicina de catástrofe», con el consecuente cambio en los parámetros de toma de decisiones. En este contexto la asignación de recursos o la priorización de tratamiento pasan a ser elementos cruciales, y es importante contar con un marco de referencia ético para poder tomar las decisiones clínicas necesarias. Para ello, se ha realizado un proceso de revisión narrativa de la evidencia, seguida de un consenso de expertos no sistematizado, que ha tenido como resultado tanto la publicación de un documento de posicionamiento y recomendaciones de la propia SEMICYUC, como el consenso entre 18 sociedades científicas y 5 institutos/cátedras de bioética y cuidados paliativos de un documento marco de referencia de recomendaciones éticas generales en este contexto de crisis.

Keywords: Catastrophe; Crisis care; Ethics; ICU; Pandemic.

Publication types

  • Consensus Development Conference
  • Practice Guideline
  • Review

MeSH terms

  • Betacoronavirus*
  • COVID-19
  • Clinical Decision-Making*
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / therapy
  • Critical Care / ethics*
  • Critical Care / methods
  • Critical Care / psychology
  • Critical Care / standards
  • Ethics Committees
  • Health Services Needs and Demand
  • Hospital Bed Capacity
  • Humans
  • Intensive Care Units*
  • Pandemics*
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / therapy
  • Precision Medicine
  • Resource Allocation / ethics
  • Resource Allocation / standards
  • Respiration, Artificial
  • SARS-CoV-2
  • Societies, Scientific
  • Spain / epidemiology
  • Triage / ethics
  • Triage / standards