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The Ethics Council of the Order of Physicians issued an opinion with recommendations on intensive care services, which establishes how specialists should act in the event of a shortage of beds and ventilators in intensive care due to the worsening of the pandemic.
It is not about making worthwhile decisions, but about reserving resources that can become extremely scarce for those who have
in addition, they are more likely to survive after treatment “underlines opinion.
The vital prognosis should be privileged, following the principle of proportionality. Saving more lives and more years of life is consistent, both with utilitarian ethical perspectives that emphasize results based on the common good, and with non-utilitarian visions, which prevail in Portuguese physicians, that emphasize the unique value of each human life “, the document also says.
For the Ordem dos Médicos, the criteria for choosing who is or is not entitled to a ventilator in intensive care “It cannot be a priority criterion: the order of arrival of the request for admission or arrival at the hospital emergency services. Although many patients are elderly, this in itself can never be used as a criterion. The presence of morbidities and the functional status of multiple organs should be carefully assessed, along with age “, defends the Ethics Council.
“Patients in whom the benefit is minimal and unlikely due to advanced or terminal illness should not, as in non-emergency situations, undergo intensive therapy. All decisions to limit access must be well founded and result from a consensus of the health team This decision must be communicated (to himself (whenever possible) and to his family members) and recorded in the process. In decision-making situations that present particular difficulties and clinical or moral uncertainty, they must seek (by phone or other means)), as far as possible, a second opinion from experienced colleagues ”, also highlights the recommendation of the Ordem dos Médicos.
The document adds that the defined criteria must be periodically reviewed and that “the support, where available from the respective teams and technicians, of any extracorporeal oxygenation means, should be reserved for strictly selected cases and with a reasonable expectation of relatively rapid abandonment. “.
The opinion further adds that “the limitation or suspension of controlled or assisted ventilation, or endotracheal or non-invasive extubation is not in itself an indication to suspend the rest of the treatment “ and that it must be verified, when the patient is admitted, “the existence of advance directives of will, which, if they exist, must be respected, as a way of recognizing the autonomy and self-determination of those who are no longer capable of expressing their will” .
The recommendations of the Order of Physicians add that “in the case of decisions to suspend curative attitudes, the doctor cannot abandon any patient who needs their care, and must always guarantee adequate palliative follow-up” and that, if “it is foreseen an agonizing period “In the short term, it is advisable to consider moving to an environment outside the ICU and respecting their privacy as much as possible”.
Palliative sedation “in patients with physiological deterioration, on the other hand, should be considered following the existing recommendations in this regard, and provided that
possible, with the collaboration of a palliative care specialist. “
The recommendation of the Ordem dos Médicos also foresees, in the case of patients who die in a situation of total absence or restriction of visits, that the possibility of saying goodbye, even by phone, to their family members is guaranteed whenever possible. “The relatives of all patients who die during this period must receive psychological and / or spiritual support appropriate to their needs and desires,” the document emphasizes.
