Covid 19 and Treatment access
The Care Quality Commission (CQC) interim review (2020), has found unacceptable and inappropriate ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) notices were made at the start of the COVID-19 pandemic. The findings come after the CQC raised concerns that older and vulnerable people may have had DNACPR decisions made without their consent or may have made them without enough details for an informed decision (Hackett, 2020). This is a sensitive question at the best of times. But consent is a precious right for all patients and to obtain it is a skill required of nurses (and doctors) with each patient admission where appropriate and possible. One example of the pressure and confusion during the early days of the pandemic, the CQC noted that guidance intended to help clinicians assess frailty as part of a wider, holistic assessment around the appropriateness of critical care, may have been interpreted as the sole basis for clinical decisions in some instances.
Coronavirus demands on the NHS resources are outstripping supply and those responsible for our care and well-being are facing challenging decisions. What may well be on all our minds is what provision will be available if I, or a loved one, is in need of treatment and life-support in these circumstances. While we would all agree that the allocation of resources must be done, as fairly, as possible, the criteria of fairness must be clear and shared by us all. These principles apply both morally and in law, which governs our expectations and rights on health and social care.
As Christians our starting point is that we are all made equally in the image of God. Human value is not a measure of our mental or physical capacity, our societal function, our age, our health or of any other qualitative assessment. God made each of us and in so doing gave us all equal dignity and value. This is never lost during sickness or dying.
It is important to bear in mind in any discussion of resource allocation and medical rationing when the tension between the appropriate treatment and scarcity of resources has, in most people’s experience, never been so visible. A decision against offering a certain life-prolonging treatment to an individual must never be a judgement based on the worthwhileness of that person’s life, including their age or other social characteristics, but a pragmatic decision about the likelihood of him/her benefiting from the intervention given their medical condition. This principle has been upheld in case law repeatedly and the NHS Constitution itself is clear that we should deliver care and support in a way that achieves dignity and compassion for each and every person we serve.
Until the current pandemic, resources have always been allocated according to medical need and benefit to the patient. Today this approach must be complemented by maximising scarce resources for the common good and so prognosis, and the likelihood of benefit becomes the overriding criteria.
People with underlying health conditions should discuss the sort of treatment they may want with their families so that good communication is possible in a crisis. Each of us may be presented with clinical scenarios which are both unwelcome and distressing, yet doctors are faced with making the least-worst decisions. This approach helps us to focus on the common good. Similarly, Catholics will focus on the benefit of a particular treatment for the person taking into consideration all medical factors. This, again, helps us to focus on the common good of all and best meets the principles of justice and equality (Moth et al, 2020).
It has been argued further that the miseries for the elderly in their care homes, to ensure their safety from Covid 19, being unable to see even one of their family members, for visits, should be weighed against the need for love and compassion. It has been realised how hard it is for the elderly in care to be without visitors, so a pilot study of one named relative being allowed to visit with regular testing, is being initiated. Every last precautionary measure of infection prevention… “should not trump the deaths in loneliness of tens of thousands. When the elderly people are no longer with us, due to their deaths by Covid 19, we shall look back on how we treated the institutionalised elderly in this year of Covid 19 and be ashamed” (Parris, 2020). This criticism cannot overlook, however, those dedicated staff, the Good Samaritans, who tried their very best to care for the vulnerable elderly in care homes which involved being apart from their own families to protect their residents from the risk of Covid 19.
Hackett, K. (2020). DNACPR notices: review finds ‘unacceptable and inappropriate’ use early in pandemic. Care Quality Commission says older and vulnerable people most at risk. Nursing Standard, 4 December.
Moth, R., Mason, P., Sherrington, J. (2020). Coronavirus and Access to Treatment, RCDOW. Monday, April 20th, 2020 @ 1:10 pm
Parris, M. (2020). It’s shameful how we have treated our elderly. The Spectator. 14 November.