COVID-19: Allocation and withdrawal of ventilation – the urgent need for a national policy
6th April 2020
This blog is written towards the beginning of the Covid-19 lockdown. We are not yet three weeks in, and do not know what the future holds. This post has already been updated once since publication and in the fast paced news of coronavirus, more updates will come. This post therefore may not be an exhaustive analysis, but we will revisit the subject as and when developments require. We would also welcome any relevant new information on the topic, especially from those at the front line: please send to email@example.com.
The Government is clear that there is not, and is unlikely to be, a situation where there are more patients nationally requiring ventilation than there are ventilators. If achieved, avoidance of the situation faced by doctors in Italy and Spain will come about by a combination of increased supply of ventilators, moving patients and ventilators around to match supply to demand, and the application of tough triage criteria, so that access to ventilation is limited to those likely to make a recovery.
But avoidance cannot be guaranteed. Local surges in demand will occur, and may lead to temporary shortages. The risk of demand exceeding supply exists. News reports in The Guardian and Daily Mail suggest that this has already happened in some hospitals.
Were that risk to eventuate, the withdrawal issue would arise:
Can a ventilator ever lawfully be removed from a ventilated patient who may be deriving benefit from it, for the purpose of providing that ventilator to different patient?
If it can, how should withdrawal and reallocation decisions be made?
In our view, these questions should be asked and answered now, before the risk eventuates, and in the profoundest hope that it never does.
Read the full article on our UK Medical Decision Law Blog.
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