Bioethics Dilemma: Who Gets to Use the State’s Limited Resources?
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Bioethics Dilemma: Who Gets to Use the State’s Limited Resources?

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Alessa Flores By Alessa Flores | Senior Journalist and Industry Analyst - Wed, 04/15/2020 - 12:36

Recently, Deputy Minister of Health Hugo López-Gatell announced the strengthening of infrastructure and health resources to face Phase 3 of the COVID-19 sanitary emergency in Mexico. Phase 3 of COVID-19 refers to the maximum phase of transmission and community contagion, during which Mexico is expected to experience the highest number of cases and will require a strict adherence to care and hygiene measures established by health authorities, according to the World Health Organization (WHO). 

WHO has emphasized the importance of not only caring for the population but managing resources efficiently to avoid saturation of health systems. If poorly managed, saturation could lead to a health catastrophe in which the number of critical COVID-19 cases exceeds the installed capacity of the country and the number of deaths could grow exponentially, said WHO. 

Figures shared by the Ministry of Health show a panorama in Mexico that is not as critical as in other countries with 5,399 confirmed cases, 10,792 suspected cases, 23,900 negatives and 406 deaths. Out of the confirmed cases, 3,525 (65.29 percent) have been non-critical and 1,874 (34.71 percent) have required hospitalization. Even though Mexico is not facing a critical saturation at medical facilities, health authorities have started to prepare to be ready for the worst-case scenario. 

Scarcity of resources forces health authorities to ask themselves how these should be allocated when two or more patients need them. For example, who would be given an extracorporeal membrane oxygenation machine when there are two patients who can benefit from it. There is no easy answer for this, which is why in the face of this potential scenario, health authorities have begun to prepare a draft of bioethical guidelines for the allocation of critical medical resources to determine who is eligible to receive these in a worst-case scenario. 

Literature tells us that this ethical dilemma goes beyond who lives or dies. Decision-making in this way is not new to critical cases such as pandemics but has been a method used in the event of natural disasters, in times of war and in saturation of hospital systems, according to an article on Resource Allocation by the Washington University. While scarcity can be mitigated by improved efficiency or increased investment most of the time, these pragmatic solutions cannot solve the problem in times of pandemics and a "rationing" decision must be taken, says the article.

The ethical guide was inspired by a principle of social justice that states all people have the same value. Therefore, the distribution of scarce resources during a public health emergency must be oriented to save as many lives as possible. This means evaluating both the possibility that a patient improves and survives, as well as the time it will take them to recover. 

The Bioethics Guideline proposes two principles to determine who accesses resources in times of scarcity. The first is to save as many lives as possible and the other is to save as many years of life as possible. The first principle says that people who can be saved in the short term will be eligible to receive resources. For example, if two people require the resources, the person with the least short time complications and the best chance of recovery will be the eligible candidate. Whereas the second principle refers to a choice based on long-term survival, where the quality of life that a person can have and the comorbidity of an individual adds up to the decision of whether he or she is a candidate. For example, if two people of the same age need critical resources and also have the same probability of surviving, the resources will be allocated to the person who, due to their healthy lifestyle and health status, will guarantee a longer life.

The guide will only come into effect if the existing critical care capacity is exceeded or is close to being exceeded and it is not possible to refer patients who need critical care to other health institutions where they can be adequately cared for, according to the draft published by the health authorities. The government has also called on health specialists, philosophers and other key actors to contribute to the bioethical guide to be prepared for a potential critical case.
 

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