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      Ethicists, doctors and triage decisions: who should decide? And on what basis?

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          Abstract

          We report here an emerging dispute in Italy concerning triage criteria for critically ill covid-19 patients, and how best to support doctors having to make difficult decisions in a context of insufficient life saving resources. The dispute we present is particularly significant as it juxtaposes two opposite views of who should make triage decisions, and how doctors should best be supported. There are both empirical and normative questions at stake here. The empirical questions pertain to the available level of evidence that healthcare professionals would rather not be left alone with their ‘clinical judgments’ to make triage decisions, and to the accounts of distributive justice that doctors and healthcare professionals rely on, when making triage decisions. The normative questions pertain to how this empirical evidence should inform guidelines on how prioritisation decisions are made in a context of emergency, and who gets to have the authority to do so. This debate goes beyond the discussion of the care of critically ill patients with COVID-19 and has broader implications beyond the national context for the discussion of how to relieve moral distress in contexts of imbalances between healthcare resources and clinical needs of a population.

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          Facing Covid-19 in Italy — Ethics, Logistics, and Therapeutics on the Epidemic’s Front Line

          New England Journal of Medicine
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            A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic

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              Surgeons, Ethics, and COVID-19: Early Lessons Learned

              In response to the COVID-19 pandemic, surgeons are being forced to shift from patient-centered ethics to public health ethics. This shift will inevitably cause moral distress for surgeons as they are forced to alter elective surgical schedules and shift to other aspects of patient care. It is imperative that we realize the changes that are occurring in the current international setting of absolute scarcities so that surgeons are best equipped to navigate these challenging ethical waters.
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                Author and article information

                Journal
                J Med Ethics
                J Med Ethics
                medethics
                jme
                Journal of Medical Ethics
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0306-6800
                1473-4257
                July 2020
                10 July 2020
                : medethics-2020-106499
                Affiliations
                [1 ] departmentGlobal Health and Social Medicine , King's College London , London, UK
                [2 ] departmentDepartment of Philosophy , University of Turin , Turin, Italy
                [3 ] Consulta di Bioetica , Turin, Italy
                Author notes
                [Correspondence to ] Dr Silvia Camporesi, Global Health and Social Medicine, King's College London, London WC2R 2LS, UK; silvia.camporesi@ 123456kcl.ac.uk
                Author information
                http://orcid.org/0000-0003-4135-1723
                Article
                medethics-2020-106499
                10.1136/medethics-2020-106499
                7371478
                32651252
                3f21b2c6-5c20-43ed-8162-1cd3aa4f2ca3
                © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

                This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

                History
                : 24 May 2020
                : 03 June 2020
                Categories
                Current Controversy
                2474
                Custom metadata
                free

                Ethics
                resource allocation,research ethics,policy guidelines/inst. review boards,history of health ethics/bioethics,ethics committees/consultation

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