Covid-19 Community Forum: Final Report

Who Makes the call?

Download full report here: Who Makes the Call – COVID-19 Forum Report

Executive Summary

The grim reality of rationing intensive care resources as a result of COVID-19 has recently been witnessed or predicted in several countries (e.g. Italy, USA). Whilst social distancing measures introduced within Australia to ensure our health system is not overwhelmed have thus far been successful, there is considerable (and understandable) anxiety among those with complex conditions and vulnerabilities that they may be denied intensive care should the situation escalate. If that occurs, multiple patients will be subject to triage and clinicians will be in the invidious position of having to make difficult life and death choices. If these choices are not guided by social as well as clinical considerations, they will default to utilitarian choices and that does not bode well for vulnerable individuals. Although some debate is occurring in this space, to date the discussion has been driven by clinicians, academics and policy advisors. A key omission in the discussion has been the voice of the consumer.

In response, on Thursday 2 April 2020, Health Issues Centre (HIC) hosted an online forum to initiate discussion around an ethical decision-making framework for triage during the COVID-19 epidemic. The forum aimed to explore the following:

A group view as to whether or not a utilitarian approach to triage can be expanded to include social justice and health equity criteria.
If so, key principles and considerations that should inform a guiding Statement of Principles.

If not, does it mean social justice and equity considerations are irrelevant or are they applied only to end-of-life management principles?
How should vulnerable communities be informed if this turns out to be the case?

One hundred and seventy-four people participated in the forum (208 registrants), providing a valuable opportunity to share concerns and perspectives of highly vulnerable groups (condition and population specific). The forum involved experts from the fields of intensive care, ethics, geriatric medicine, ageing and cancer survival giving a series of informative and thought-provoking talks. The video of the plenary session can be viewed at: https://hic.org.au/covid-19-forum-video/. The presentations were followed by breakout groups where participants were asked to generate key insights, statements, concerns and/or principles. These statements were compiled into six salient themes – community participation, communication, information/education, clinical guidelines, health workers and ethical framework – and a post-forum survey was conducted to gauge the level of group consensus/endorsement.