SPECIAL ARTICLE   Free access

Minerva Medicolegale 2020 March;140(1):1-7

DOI: 10.23736/S0026-4849.20.01791-5

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Health care access in shortage of health resources circumstances: ethical and legal considerations

Adriano TAGLIABRACCI ✉

Section of Legal Medicine, Department of Excellence-Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy

On 13rd March 2020, the “Società Italiana di Algologia Anestesia Rianimazione e Terapia Intensiva” issued the recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances, like the COVID-19 pandemic. In this document, common admittance/discharge criteria in ICU, based on the utilitarian approach, were proposed in response to the necessity of care personnel to face the issue of discriminating patients to be connected to ventilators due to the respiratory failure. According to these recommendations, the chronological age is the first criterion to be applied, along with comorbidity and functional state. Although this document drawn the attention on critical problem of Public Health System, this position entails elements of discrimination against fragile people and patients with comorbidities. It is accepted that this approach does not follow the Constitutional principle of public health protection. On the other hands, national and internationals Bioethics Committees proposed a different approach in respect to the clinical triage as first instrument for the decision-making process. The principles of clinical suitability and actuality are also proposed to create a common model to be adopted in Intensive Care Units. The bioethics and legal aspects of the proposed criteria and recommendations are discussed by the author. The documents issued by the national and internationals committees and associations are compared to evaluate the more appropriate approach under ethical and legal point of view.

KEY WORDS: Bioethics; COVID-19; Health resources