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Prepared by Osler’s Ethics Quality Improvement Lab, P Chidwick, J Oliver 20MARCH2020 12:00 pm
Ethics Framework
For Health System Preparation
For Major Surge in a Pandemic:
Steps Before Triage
Draft 4, March 20, 2020
Prepared by Osler’s Ethics Quality Improvement Lab, P Chidwick, J Oliver 20MARCH2020 12:00 pm
Ethics Framework for Health System Preparation for Major Surge in a Pandemic:
As you are aware, things are changing rapidly in Ontario in response to the COVID-19 Pandemic. It is possible that at some point health care providers could be faced with very difficult decisions related to resource allocation. If the surge in patients as a result of COVID-19 overwhelms Ontario’s critical care units, there may be more patients who need critical care than there are beds available. If such a situation arises, decisions will have to be made about who accesses these beds and who does not. In order to preserve and promote trust, solidarity, and equity, and to ensure that such decisions are made only when necessary and as a last resort, it is crucially important that Ontario’s health care system confirms that all legal and professional obligations, as well as obligations related to autonomy, and stewardship are currently being met. By meeting these obligations now, we will safeguard our health care professionals from making resource allocation decisions before we would be ethically justified in doing so. Our obligations to future patients require us to carefully evaluate our treatment of current patients. We can do this now.
Prepared by Osler’s Ethics Quality Improvement Lab, P Chidwick, J Oliver 20MARCH2020 12:00 pm
For each patient admission or patient currently in the unit
Is the Standard of Care being followed?
Ensure that the correct substitute decision maker is
identified in case a new proposal is made
Is the current plan in line with the patient s known
wishes, if any? Propose a new plan that is in line with the
standard of care and the patient s known wishes
(if known) or best interests (if no wishes
known)
NOYES
NO
YES
Is the current plan in the patient s best interests?
YES
NO
Ensure the following actions take place throughout:
Consent and Capacity Board mechanisms are accessed wherever appropriate, and process is started as soon as possible
The first correct substitute decision maker is identified and contact information recorded
The next correct substitute decision maker is identified and contact information is recorded
The patient s wishes, values, and beliefs are asked about and documented
All substitute decision makers are provided with information about their role
A person who is incapable, unwilling, or unavailable is not approached as a substitute decision maker
Substitute decision makers are required to provide their decision within a reasonable time, based on the patient s current condition
Redistribution strategies (i.e. decanting, admission) are explored and implemented
CRITICAL CARE UNITS
GOALS
Ensure current ethical, legal, and professional
obligations.
Patients access Rx that they want and can
benefit from, and they do not access Rx they do not want and cannot benefit
from.
Prepared by Osler’s Ethics Quality Improvement Lab, P Chidwick, J Oliver 20MARCH2020 12:00 pm