if the NHS gets overwhelmed with very
ill kovat 19 patients
what should health care workers do who
gets a bed who should have a ventilator
who gets priority for the UK's 240,000
doctors who will be down to them to
decide and while they wait for the
government to issue official guidelines
the British Medical Association have
given their own advice to doctors today
these are the worst case scenarios they
may be thinking about in the weeks ahead
doctors are used to making
life-and-death decisions but in a
pandemic if the system is under intense
pressure what should they do then their
professional association has come up
with these guidelines to help in some of
the most challenging decisions they'll
have to make when it comes to age the
BMA says a cut-off would be unlawful but
older patients with severe respiratory
failure may have a very high chance of
dying and would be lower priority for
admission to intensive care patients who
are ill in the early stages of the
pandemic are more likely to be cared for
in intensive care and get a ventilator
than those who become similarly ill
later the BMA also says that we may
reach a stage where priority over
treatment would be given to essential
workers to keep the Health Service and
other key sectors running and limit
economic losses but they say it's up to
the government to decide who these
people are and not doctors these
decisions have already been made in
countries which have had high numbers of
deaths from covert 19 like it's the
China and Spain medical ethics expert
dr. Jonathan Ives welcomes the advice
people so that there's time to have a
public conversation about it's very
important the public are aware I know
involved in these kinds of discussions
and decisions as far as well we're still
waiting on the government here in the UK
to issue their guidance on what doctors
will potentially have to do likewise
updated advice on who gets personal
protection equipment is still an issue
yet to be tackled by them currently only
dealing with patients have high priority
over this equipment hospital patients as
the pandemic progresses unions for
health care workers are looking to the
government to give them clear guidelines
on how to make some of these tough
decisions I should tell reporting while
joining me now from London is Jillian's
either a special advisor in ethics and
human rights to the British Medical
Association people will wonder what this
means in real terms does it mean that if
you have a potentially life limiting
condition whether it's heart disease or
something else
doctors would be correct to put you
further down the list of priorities for
treatment when it comes down to it I
think it's absolutely essential that we
recognise that nobody wants to be making
these kinds of decisions but if we do
get to a situation where resources are
absolutely overwhelmed by need the
question arises is what does fairness in
the distribution of those life-saving
interventions look like and one of the
issues that will be put into place are
questions around capacity to benefit as
I say to repeat if if if resources are
overwhelmed questions about how to
prioritize how best to distribute those
resources become urgent now the
guidelines say it shouldn't just mean
that age means that you don't get what
scenario would old a person be
prioritized over a younger person if for
example the older person was fit and
healthy and the younger person had
underlying comorbidities that meant they
were very unlikely to benefit from the
intervention then the older person would
be prioritized what we're interested in
is identifying clinically
relevant factors for the distribution of
these resources age in and of itself
will not be a clinically relevant factor
unless it is associated with underlying
morbidities I mean how helpful do you
think this is as a public debate I mean
do you actually want people to think
about whether they should be going to
hospital themselves is that is that kind
of what the purpose of this is for
families to decide whether they should
try and go into intensive care or
whether they should actually die at home
I mean the guidance is both for and it's
principally faced towards medical
professionals trying to support medical
professionals when they are confronting
these incredibly harrowing decisions
they don't want to make them nobody
wants to be here I also think it's a
it's an excellent idea that people
decide in advance how they might like to
be treated
if these circumstances arise it's a
matter of individual choice and freedom
and autonomy and and it's a I mean we
strongly recommend that people start
having those conversations now do
doctors want a firm set of guidelines to
be handed down to them or are they
happier working within the framework
they've always worked with and with
these sorts of guidelines themselves one
of the things we want to ensure where a
number of things we want to ensure we
want to ensure that doctors are
supported feel confident when they are
forced to make these harrowing decisions
if we can get centralized advice and
guidance from the government that our
guidance can lock into then so much the
better it's far better if the government
and the profession speak with a single
voice on these issues that will give
confidence to doctors and it'll give
confidence to patients that these
decisions that made as fairly as
possible in these demanding
circumstances