Triage during the Covid-19 epidemic in Spain

Better and worse ethical arguments

Bibliographic Data

ID21514869
AuthorsBenjamin Herreros (0000-0001-6708-7102, Internal Medicine, Hospital Universitario Fundacion Alcorcon Servicio de Medicina Interna, Alcorcón, Comunidad de Madrid, Spain, corresponding author), Pablo Gella (Instituto de Ética Clínica Francisco Vallés, Universidad Europea de Madrid Campus de Villaviciosa de Odón, Villaviciosa de Odón, Madrid, Spain), Diego Real de Asúa (0000-0002-1445-5597, Hospital Universitario de La Princesa)
Year2020
Volume46
Issue7
Pages455-458
Publication date2020-07-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueJournal of Medical Ethics (JOURNAL)
Journal identifiersISSN: 0306-6800 • E-ISSN: 1473-4257
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/medethics-2020-106352
PMID32424063
OpenAlexW3025821090
LanguageEN
Citations received18
References cited7

The COVID-19 pandemic has generated an imbalance between the clinical needs of the population and the effective availability of advanced life support (ALS) resources. Triage protocols have thus become necessary. Triage decisions in situations of scarce resources were not extraordinary in the pre-COVID-19 era; these protocols abounded in the context of organ transplantation. However, this prior experience was not considered during the COVID-19 outbreak in Spain. Lacking national guidance or public coordination, each hospital has been forced to put forth independent and autonomous triage protocols, most of which were, nonetheless, based on common ethical principles and clinical criteria. However, controversial, non-clinical criteria have also been defended by Spanish scientific societies and public institutions, including setting an age cut-off value for unilaterally withholding ALS, using ‘social utility’ criteria, prioritising healthcare professionals or using ‘first come, first served’ policies. This paper describes the most common triage criteria used in the Spanish context during the COVID-19 epidemic. We will highlight our missed opportunities by comparing these criteria to those used in organ transplantation protocols. The problems posed by subjective, non-clinical criteria will also be discussed. We hope that this critical review might be of use to countries at earlier stages of the epidemic while we learn from our mistakes

Environmental health · Health care · Medical emergency · Pandemic · Pathology · Political science · Population · Public health · Public relations · Triage · Cardiac Arrest and Resuscitation · Disaster Response and Management · Law · Medicine · Nursing · Palliative Care and End-of-Life Issues

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