Covid 19: clinical decision-making in conditions of resource shortage and the “pandemic emergency triage” criterion

8 April 2020


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In the context of the Covid-19 pandemic, the healthcare system has been subjected to enormous pressure. In this opinion, the Committee examines the problem of patient access to treatment in conditions of limited health resources.

In accordance with the fundamental principles of the Constitution (the right to health protection, the principle of equality, the duty of solidarity) and the universalistic and egalitarian criterion on which the National Health Service is based, the Committee believes that there must be respect for the principles of justice, fairness and solidarity, in the allocation of resources. In this context, the ICB recognises the clinical criterion as the most appropriate point of reference, deeming any other selection criterion, such as age, sex, condition and social role, ethnicity, disability, responsibility for behaviours contributing to the onset of the pathology, costs, to be ethically unacceptable.

The Committee believes that pandemic emergency triage should be based on a premise, preparedness (preparation of action plans in the field of public health care, in view of exceptional conditions, with a transparent chain of responsibilities), clinical appropriateness (medical evaluation of the efficacy of the treatment in relation to the clinical need of each individual patient, with reference to the urgency and seriousness at the onset of the pathology and to the prognostic possibility of recovery, considering the proportionality of the treatment), actuality that places the individual evaluation of the patient physically present in the emergency department into the broader perspective of the "patient community", with a periodic review of waiting lists.

The Committee also points out that the allocation of health resources in conditions of their scarcity requires maximum transparency towards the public, in order to render everyone's choices truly free and informed. The ICB notes with concern the proliferation of legal disputes against health professionals in the context of the current pandemic emergency and believes that there should be consideration of the idea of limiting possible profiles of professional liability of healthcare workers in relation to the activities carried out to deal with the Covid-19 emergency.

Specific attention is dedicated to those most vulnerable, who may feel at risk of abandonment, in particular the elderly, in residential care facilities, for whom the Committee recommends that appropriate care, protection and attention should be ensured in order to prevent Sars-CoV-2 virus infection.

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