Interview with Elysee Nouvet

Ethical Questions During a Pandemic

How to prioritize patients who will not receive critical care

Jessica Singer

As the COVID-19 outbreak rapidly evolves, countries across the world are facing a situation of overwhelmed hospitals, respirator shortages, and a lack of medical supplies.  

While the pandemic continues to put a strain on healthcare systems worldwide, not everyone will be able to receive the care they normally would under ordinary circumstances.

Yet, what is the plan for patients who are not prioritized for critical care? And how will this information be shared with those who are affected?

These ethically fraught questions are being investigated by researchers at Western University and McMaster University in a new research study, “Triage and COVID-19: global preparedness, socio-cultural considerations, and communication.”

Researchers are investigating what is ethically crucial to the care and treatment of patients who will not be prioritized for critical care during the COVID-19 pandemic.

“Minimally discussed in the media, and I was struck by this, is the plan for individuals who are not prioritized for a respirator, or even potentially for transport to hospital if we get to a situation where the pandemic is putting such a strain on our healthcare system,” explained Elysée Nouvet, medical anthropologist and assistant Health Studies professor at Western University.

In Canada, the dominant logic on how to cope with the pandemic is largely utilitarian: with limited resources and increased need, the utilitarian approach focuses on how Canadians should use resources to lose the least amount of lives possible.

“In the mainstream presentation of the utilitarian perspective, we are hearing that resources are best allocated to those most likely to benefit from them in the short and the long term,” said Nouvet.

“There’s this kind of consideration of how many years people would normally have left based on their age or life expectancy.”

There’s an overriding belief in Canadian society that young and healthy patients should be prioritized, as ageism continues to be one of the most disregarded forms of social prejudice.

Yet, these value-judgements may not resonate nationally or societally.

“The norm in North America is for members of our society to decrease in social importance beyond a certain age,” explained Nouvet.

“I think that resonates strongly in many places, but it won’t resonate everywhere...If you think of Indigenous culture in Canada, elders in Indigenous communities have knowledge and social roles that are hugely valued.”

What it means to be healthy, valued, and productive varies depending on different cultural and social dynamics.

This means that these crucial, ethical decisions cannot be made by a small group of experts. “There has to be some consultation with the affected population,” Nouvet stressed.

Ethicists want to ensure citizens are represented in the decision-making process. Committees are also being struck to create guidelines on which patients to prioritize if hospitals are overwhelmed by COVID-19 cases to alleviate the stress of healthcare professionals.

“There’s a sense that it might be better for healthcare providers, for those who are on the front have their marching orders from a committee,” clarified Nouvet.  

“Because making those decisions live [and] as the situation constantly changes is extremely stressful.”

While critical care might not be an option for every patient if Canada does face an overwhelmed situation, there will always be a responsibility to care and provide care.

“If somebody is not able to access the level of care they would normally receive under non-pandemic circumstances, what can be done to support them, what can be done to support the people at their side, what can be done to support the healthcare professionals,” emphasized Nouvet.

Although Canadians are hoping the situation of overwhelmed hospitals does not affect our nation in the same capacity as the world’s most hard-hit regions, it’s important to discuss how to prepare for the safety of our community and our loved ones.