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The authors discuss the difficulties relative to triage and allocation that clinicians have faced and may face during the COVID-19 pandemic. They suggest that crisis standards should be declared by authorities, and clinicians should be guided by these decisions, which may result in less autonomy to maximize the number of lives saved. There should be equal access to scarce resources for all patients. Effective communication and good palliative care are vital to ensure optimal delivery of care to all patients.
As more evidence emerges about COVID-19, difficult clinical decisions can be more easily guided by prognostic factors.
This abstract is available on the publisher's site.
The COVID-19 pandemic and its sequelae have created scenarios of scarce medical resources, leading to the prospect that health care systems have faced or will face difficult decisions about triage, allocation, and reallocation. These decisions should be guided by ethical principles and values, should not be made before crisis standards have been declared by authorities, and, in most cases, will not be made by bedside clinicians. Do not attempt resuscitation and withholding and withdrawing decisions should be made according to standard determination of medical appropriateness and futility, but there are unique considerations during a pandemic. Transparent and clear communication is crucial, coupled with dedication to provide the best possible care to patients, including palliative care. As medical knowledge about COVID-19 grows, more will be known about prognostic factors that can guide these difficult decisions.