COVID and healthcare rationing
Stephen Honeybul1, Sir Charles Gairdner Hospital PERTH 1Sir Charles Gairdner Hospital, PERTH, WA, Australia
Abstract
Many would attest to the extreme pressures that were placed on healthcare resources during the recent COVID pandemic where healthcare administrators and clinicians were often called to make hasty decisions regarding resource allocation based on very limited experience. Whilst the worst effects of the COVID pandemic appear to over, given the evolving nature of the corona virus’s and the increasing ease and frequency of intercontinental travel, it would appear unlikely that it is the last such healthcare crisis.
Because of these observations, there would appear to be a strong case for robust pre pandemic planning given that the memories of such difficult circumstances are relatively fresh in our minds. The key issues in the COVID pandemic centred on resource allocation and the difficulties of adopting measures such as a frailty index (which was never utilised) when considering the utility or otherwise of providing respiratory support and in some cases limiting admission to intensive care beds.
In the context of neurosurgery, it may be necessary to consider limiting the availability of certain neurosurgical services (as occurred in the COVID pandemic but in a very ad hoc fashion and unplanned fashion) or perhaps reconsider the utility or otherwise of performing procedures that commit very restricted resources, such as intensive care beds, to patients who are arguably receiving limited long-term benefit. In these circumstances, the decision-making paradigm is challenging and there are several ethically disparate viewpoints that need to be reconciled, which include futility, utilitarianism and the Rule of rescue.
Biography
Previous State-wide Director of Neurosurgery in Western Australia, a fellow of the Royal College of Surgeons of England, The Australasian college of Surgeons and a member of the Neurological Society of Australasia. Past member of the Neurosurgical training Board of Australia and Past Chief Examiner for the FRACS in Neurosurgery. Current interests involve clinical ethics and stem cell driven cranial reconstruction.