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One of the few certainties in times of pandemic is uncertainty. Fear too. What will happen if the response capacity of the National Health System is silenced by the abundance in the scarcity of everything? Where will medical ethics go if beds are not available in intensive care units? How can a doctor fill his chest with his duty if he only has one ventilator for two patients? Choices will have to be made. Ethical coordinates are urgently needed to avoid drift and an opinion from the Ordem dos Medicos guides the decisions that no one wants to make. The document continues with a set of considerations and recommendations to institute a “process for screening patients” who “need intensive care”, since the “order of arrival of the request for admission or arrival at hospital emergency services” does not constitute priority criteria. Thus, “it is not about making valuable decisions, but about reserving resources that can become extremely scarce for those who, above all, have a better chance of surviving after treatment.” The goal, he says, “is to save more lives and more years of life.” One of the factors that weighs in the decision is “the presence of comorbidities and the functional status of the multiple organs”, which must be evaluated “together with age”. Furthermore, “patients in whom benefit is minimal and unlikely due to advanced or terminal illness should not, as in non-emergency situations, undergo intensive therapy.” In the case of decisions to suspend curative attitudes, “the doctor cannot abandon any patient”, “always ensuring adequate palliative care”. The Order of Physicians also suggests that, “if a short-term agonizing period is anticipated, transfer to a setting outside the ICU should be considered and to the extent possible respecting their privacy. The opinion may be consulted in its entirety HERE. The president of the Portuguese Bioethics Association, Rui Nunes, clarifies how the blackest of all scenarios could be. And why it is necessary to be prepared for this scenario despite the fact that the professor of the Faculty of Medicine of the University of Porto is almost certain that this point will not be reached.
