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Covid-19: Doctors question ethics of treating adults in paediatric ICUs

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4144 (Published 27 October 2020) Cite this as: BMJ 2020;371:m4144

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  1. Clare Dyer
  1. The BMJ

Two hospital doctors are questioning whether adult patients would be able to give informed consent to being treated in children’s intensive care units if adult services became overwhelmed again during the covid-19 pandemic.1

Thomas Hampton and Victoria Sadlers, both specialist registrars at Alder Hey children’s hospital in Liverpool, ask whether patients can give informed consent to transfers to paediatric intensive care units when “the definite quality of care provision is not quantifiable, and mortality cannot be compared between sites, so the care received cannot be proved to be equal or superior to that provided by our adult counterparts.”

In a letter to The BMJ they said that “novel ethical decision making” was required in the first covid-19 wave, when adult patients were treated in Alder Hey’s intensive care unit. “Anticipating major pressures on services, our institution formed a clinical decision making committee and a clinical ethics committee,” they wrote.

“This multidisciplinary team met daily to provide guidance and support and to tackle any ethical matters that arose. A substantial concern remains, however, regarding the lack of consent for transfer of critically ill patients to units that do not usually treat adults.”

The two doctors cite new General Medical Council guidance on decision making and consent, due to come into force on 9 November.2 “This almost directly contradicts the pandemic mindset in which it is accepted that resource allocation is a key part of distributive justice from a utilitarian perspective.”

They ask, “Can we expect staff to seek informed consent from the patients for their transfer between hospitals when the objective details of outputs and outcomes are not yet appreciated by the staff themselves?”

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