Shaun Lintern on the Ethical Choices of Rationing Patient Care

[EmbarrassingAdmissions]

Shaun Lintern has an excellent reputation for being a champion for patient safety and was instrumental in covering several Trust scandals and enquiries. This is an article about London/SE at present but the same issues might be true elsewhere - although I hope they can be averted.

At one hospital trust, medics have been told they may have to accept a “just good enough” standard of care for patients in coming weeks, while the medical regulator has said it recognised difficult decisions were being made “day after day, shift after shift” across the country.

The situation facing many hospitals has prompted renewed calls for national advice to clinicians on how they should approach the so-called rationing of care – where treatment choices are balanced against the resources available and the needs of other patients.

www.independent.co.uk/news/health/coronavirus-hospitals-nhs-rationing-ethics-b1787310.html

This has been our biggest fear since the publishing of nice guidelines last year.

DS has SN and is vulnerable. As DD said in March "If this gets really bad, DS isn't getting treated is he". I had to answer no.

The main purpose of lockdown is to ensure everyone who needs treatment gets it. Otherwise the death rate won't be as low as it is.

Yes. Keep the transmission low and wait until more of us have been vaccinated.

This is something I have been battling about in my head. My MIL is 89 and just been diagnosed with covid. ICU beds are obviously being filled very quickly, so hard decisions are likely to have to be made. I am aware that however it is looked out she won't be a huge priority for intensive intervention, but actually is that the right thing? Is having good end of life palliative care better than trying to extend a life that has considerably shrunk anyway?

There are no easy answers, but we can't be ruled by emotions.

ICU type care may actually not be the right thing for a frail 89 year old. It can be hard to recover from ICU type treatment, even for younger patients. Good care on a less intensive ward might in fact give a better outcome.

Shaun's Twitter thread on his article is worth a look for some very sensitive discussion from various consultants who seem to be only too pleased that there's open coverage of this issues:

twitter.com/ShaunLintern/status/1350471498138595328

The consultants would agree that there are some people who are so frail that supportive care is more appropriate than invasive. Their concerns are about other possible triage choices that they might be facing.

My MIL is 89 and just been diagnosed with covid. ICU beds are obviously being filled very quickly, so hard decisions are likely to have to be made.

It's a bit bigger that that, theres a NICE "clinical frailty score" here that has been around since march last year. if a healthy 50 year old and my DS(13) with clinical vulnerabilities arrived in ICU and there was only one bed, it's not inconceivable he could get "deprioritised" for care.

If DS and one of my DD's friends sibling with severe special needs, were in the same situation, the the sibling could end up deprioritised for care. If fact not even recommended for ICU care. Simply because they are disabled with multiple care needs.

It's a pretty heavy. I can't imagine having to be the doctors making that decision with people so young.

And yes it is a bit like a black shadow chasing you. Its driven much of our decisions since then.