Ethics In A Time Of Coronavirus

By the time this issue of the Journal is published, the world will have moved on. More will be known, than at the time of writing this, about how medicine and societies are responding to the ethical challenges presented by the COVID-19 coronavirus pandemic. In his guest editorial, (first published online on first April 2020), Dominic Wilkinson writes (see pp 287–288) from the perspective of a UK clinician and ethicist facing the then still impending likelihood that ‘the number of critically ill patients will overwhelm the capacity of intensive care units’ and that ‘it will simply not be possible to provide mechanical ventilation to every patient who might need it’. The ‘unpalatable question’ for clinicians then will be ‘which patient to save’?\n\nIn his response to this question, Wilkinson identifies benefit and fairness as the key ethical values at stake in such triage decisions: ‘how much ethical weight is given to each of these values’, he argues, will depend not only on the need to find a fair balance between them, but also on the availability of resources. ‘As resources become more limited’, he writes, ‘there is some need to temper equality with benefit’. In the limited provision of publicly funded intensive care, there already exists ’a need to decline admission to intensive care for some patients who have a low probability of survival, or of benefiting from the treatment’: but ‘in a situation where resources are overwhelmed, and choice cannot be avoided’, he argues, the ethical balance must shift to emphasizing benefit’, which in practice means prioritising ‘those patients who have the highest chance of surviving’, or ‘a shorter duration of intensive care stay’.\n\nWilkinson does not …