"Many patients will be excluded"

2020-03-28-001604 (Phone)Healthcare may also need to opt out of patients who have good prospects of surviving. This is what Lars Sandman, professor of health care ethics at Linköping University, says, who has led the work of developing new guidelines for priorities in healthcare.

Having to prioritize patients is something healthcare must do even in ordinary cases, for example in the event of major accidents. But the differences are still clear from the situation that awaits.

– There can be a traffic accident with ten people when the care is poorly staffed and can only take care of five of them. But now many will have to opt out for a long time, which is unique. You do not see the same light in the tunnel as in the traffic accident, says Lars Sandman.

Together with other researchers, he has, on behalf of the National Board of Health and Welfare, produced the document “National principles for prioritization in intensive care under extraordinary conditions.” A work that has gone at record speed.

– Normally it takes many months, now we have done it in a week and a half. We must be ready if we come to a situation similar to Italy’s, says Sandman.
Three categories

To prioritize which patients should receive care, they are divided into three categories, based on how likely it is that the patient will survive. Level three is about patients where the probability of survival is low, while the opposite applies to level one. If it needs to be prioritized within the levels, it must be done on the basis of the expected remaining life expectancy, also called biological age.

– In normal healthcare operations, you can be faced with difficult priorities, but then often at level three. Now it may be that we have to prioritize at level one, care may therefore need to exclude even patients who have good prospects to cope, says Lars Sandman.

How close is Sweden to such a situation today?

– It is possible that it is starting to approach that situation in Stockholm, but in the rest of the country it is still a while.
Conspiracy theories

The document addresses that healthcare professionals in connection with the difficult decisions that must be made can experience ethical stress.

– We have seen from both Italy and China that staff have to pay with their mental health when dealing with ethical stress. Hopefully, the guidelines can reduce stress, when the staff knows that there is a basis behind the tough decisions, says Sandman.

In addition to helping healthcare staff, Lars Sandman hopes that the document will make it clear to citizens what applies.

– Conspiracy theories have already been spread about how the priorities will go. It is clear in the guidelines that you must not take into account things like social situation or how you have been exposed to the infection.

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