Tribune. According to a working document prepared by resuscitators from Marseille [révélé par le média en ligne Mediapart le 24 décembre 2021], a sorting could be done among patients with Covid-19, due to the lack of places available in intensive care. In the disaster scenario envisaged by the resuscitators, patients over 65 considered fragile may not be admitted. The debate on the prioritization of patients with Covid-19 is unfortunately not new. The situation at the end of the summer in the West Indies further revealed that, due to lack of space, not all patients could be admitted to intensive care. The situation in metropolitan France risks, once again, to underline how much this problem which is both ethical – who to admit? – and politics – how many beds do we have? – risk of causing conflicts within hospitals and civil society.
Ideally, in the event of a match between needs and resources, the duty of caregivers is to admit any patient who may benefit from it in intensive care, according to an individual principle of proportionality, justified according to medical criteria (patient’s condition, comorbidities) and non-medical (patient’s wishes, degree of autonomy, etc.), and according to a collective principle of equal access to care. In the event of a mismatch between needs and resources, which has become customary in a country-wide macro-allocation context, choosing to prioritize a particular public service, or unusual in the event of a health disaster, the principle of utility – saving the most lives – seems morally justified.
In this perspective, the learned intensive care societies issued, in April 2020, recommendations on the most objective possible criteria for admission to intensive care of patients with Covid-19, in order to prevent caregivers from making arbitrary decisions under the influence of fatigue and emotion. Thus, the decisions to admit or not to admit to intensive care were based on the severity of the cases, in fact favoring the patients with the best chance of survival. No age criterion was accepted, even if it is clear that the oldest, considered too fragile, could not benefit from intensive care in these situations of massive influx of patients.
It is difficult to know if these recommendations could be evaluated within each hospital; it seems, however, that they obtained the consent of the greatest number of caregivers, even if debates may have taken place, through the intermediary of local ethics committees or not, on the relevance of these criteria, sometimes perceived as too arbitrary. In all cases indeed, these triage practices have led to moral dilemmas for caregivers, patients and families.
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