MDDUS advice for members taking challenging ethical decisions during Covid-19

Medical defence organisation MDDUS offers advice to members who may be required to take challenging ethical decisions during the Covid-19 outbreak

In the coronavirus/COVID-19 pandemic clinicians may be called upon to make difficult ethical decisions, such as: which patient gets the last ventilator?

The MDDUS understands that doctors are concerned about the potential GMC, or even criminal, ramifications of withholding or withdrawing treatment from patients based on availability of resources. We are here to support our members through this challenging time and wish to reassure clinicians that you are not alone if you are faced with such a situation.

The MDDUS liaises regularly with the GMC and other relevant bodies, and we will continue to do so as the current situation evolves to ensure the guidance is as clear and applicable as possible.

Doctors must ensure that they act in accordance with the law. No one should not feel pressure to make a difficult decision in isolation, you should involve your colleagues in challenging decisions or contact MDDUS for advice.

The MDDUS advises that doctors involve their NHS employer’s legal team early where they have concerns about making a particular decision to withdraw or withhold life-sustaining treatment from a patient. In situations, such as considering reallocating life-saving treatment from one patient to another due to limitations on resources, the employer’s legal advisers should be informed without delay to ensure access to relevant emergency court / judicial involvement. A doctor would be assisted by their employer and their legal representatives when making such critical decisions. MDDUS members can also access expert advice and support via our telephone advice service.

Where an NHS hospital doctor is unsure how to contact their employer’s legal advisers in an emergency, they should speak to the clinical lead or on-call manager.

The GMC’s Treatment and care towards the end of life provides guidance to doctors caring for patients approaching the end of life, including those patients with life-threatening acute conditions caused by sudden catastrophic events. The GMC reminds doctors that they must continue to make the care of patients their first concern. Their guidance highlights that doctors should not make decisions about withholding or withdrawing care solely based on resource constraints. However, the GMC’s guidance in relation to the COVID-19 pandemic recognises that doctors may be asked to make urgent and clinically complex decisions, and that their practice may change at this unprecedented time. Nevertheless, doctors must ensure decisions are individualised to that patient and take account of all relevant factors, such as clinical appropriateness and the patient’s wishes. Doctors must be able to explain and justify any decisions they make or action they take.

MDDUS members may contact the MDDUS for advice and support.