Bioethical perspective for decision making in situations of scarcity of resources during the COVID-19 pandemic

Abstract

Lack of resources available in intensive care units (ICU) during the COVID-19 pandemic requires bioethical guidance to respond to dilemmas presented in health teams. A person-centered ethical analysis (PCEA) for ICU clinicians, becomes the best alternative to morally justify extreme decision-making in the scarcity of available resources. The goal is to make a selection based on bioethical and clinical criteria, considering a holistic view of the person, and not just a utilitarian or first-come, first-served criterion as the one set out by colleagues from Oxford University, known as RAPR (Resource Adjusted Probability Ratio) ethical algorithm for rationing life-sustaining treatment during the COVID-19 pandemic. For this reason, fundamental bioethical principles emphasizing therapeutic proportionality and how to make an appropriate moral judgment that conveys to a sensible decision-making ethically grounded are explained, considering a flow chart proposed by colleagues from the Pontifical Catholic University of Chile. In this paper we propose the PCEA Algorithm to assist ICU teams in decision making regarding fair resource allocation and care delivery during an overwhelming pandemic scenario.