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The Indian Society for Legal Affairs (ISLA) has written to the government raising concern over the absence of regulations or guidelines for allocation of scarce medical resources during a public health emergency such as the COVID-19 pandemic.
On the need for guidelines to ensure the equitable rationing of such medical resources, the letter highlights the there is evidence to show that, across the world, the healthcare infrastructure required to deal with the pandemic exceeds the available resources.
To address the same, the representation further highlights that many countries including the UK, Italy, and the US have already published guidelines to help doctors and hospitals in allocating scarce medical resources in the midst of a pandemic.
Given that India is yet to implement any such measure to address the scarcity of medical resources during the COVID-19 health crisis, the ISLA has urged that appropriate guidelines be introduced while keeping in mind the following broad considerations:
Maximisation of scarce resources: It has been recommended that patients with greater life expectancy should be given more preference in allocation of scarce medical resources, given that the principle of sickest first for critical care may not apply during a pandemic. The representation adds that the future quality of life of the patient should be an incidental objective that should assume relevance only when choosing between two patients with the same prognosis. Further, it would be highly recommended that consent forms signed by patients admitted into ICU or in need of a ventilator incorporate the possibility of removal from the ICU or withdrawal of ventilator at the time of admission. This would prevent doctors and healthcare professionals from wanton litigation relating to professional liability and criminal negligence.
Alternative medical support when it comes to patients who do not respond to ventilator support or ICU treatment over time, and who may have these treatments withdrawn.
Establishment of expert committees of triage officers: It is noted that medical ethicists have been advocating that tough choice of allocating of resources to a patient in the times of a pandemic should be taken away from the frontline clinicians. Instead, senior specialized physicians who have prior experience and training in triage should make these choices. The triage committee shall help in applying guidelines; assist in rationing decisions, and even in the outright implementation of choices, relieving the individual front-line clinicians of that burden.
Duty to safeguard frontline doctors and healthcare professionals: Healthcare professionals, doctors, nurses and medical students are exposed to an advanced risk of getting infected from COVID-19. Therefore, priority in extending clinical interventions including PPE, testing, ICU beds, and ventilators should be given to these groups. The representation adds that the failure to do so is bound to bring the system under colossal strain as more infected and sick healthcare professionals means lesser patients in need of critical care either infected by COVID-19 or not being attended.
Equitable distribution between COVID-19 and non-COVID-19 patients
The representation signs off by noting that,
“India has emerged as key stakeholder in fighting the pandemic. International organizations and countries alike, have praised the response of the Indian Government in unison for its efforts in pushing back the deadly virus. Having regulations as suggested in this representation will only improve India’s preparedness in the global fight against CoVID-19. In that spirit, we urge the Hon’ble Minister to recommend the Board of Governors to frame regulations under the MCI Act as soon as possible.”
[Read the Representation]