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Year : 2022  |  Volume : 6  |  Issue : 3  |  Page : 61-67

Awareness, opinion, attitude of intensive care unit specialists about the ethical guidelines for dealing with clinical decisions regarding the allocation of scarce resources during the COVID-19 pandemic

1 Division of Neurology, Department of Medicine, Security Force Hospital; Clinical Excellence Administration, Riyadh Second Health Cluster, King Fahad Medical City; Clinical Assistant Professor, Collage of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
2 Department of Family and Community Medicine, College of Medicine; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
3 Assistant Professor in Medical Ethics and Law, School of Medicine, Trinity College Dublin, Dublin 2, Ireland, Europe

Correspondence Address:
Faisal A Al-Suwaidan
Department of Medicine, Division of Neurology, Security Force Hospital, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sccj.sccj_17_22

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Background: With the escalation of the coronavirus disease (COVID-19) pandemic, critical care specialists have been challenged by ethical issues related to the distribution of scarce resources. Many relevant guidelines have been published worldwide. The Saudi Critical Care Society included a local framework for ethics in its first clinical guidelines for clinical decisions regarding the allocation of scarce resources during the COVID-19 pandemic for COVID-19 patients in intensive care units (ICUs). This study aimed to assess the awareness, opinions, and attitudes of ICU specialists concerning these ethical guidelines and the proposed definitions. Methods: A descriptive cross-sectional study using a self-administered questionnaire was conducted. The study population included 300 ICU physicians in Saudi Arabia who were members of the Saudi Critical Care Society. Results: A total of 70 participants (23.3%) responded to the questionnaire. Most were male, non-Saudi, and Muslim. Professionally, they were mostly intensivists with 10 or more years of experience. The most agreed-upon suggested definitions were “health crisis,” “salvageable patients” category, and the “necessity scale” (32; 45.7%, 37; 52.9%, 52; 74.3%, and 34; 48.6%, respectively). Less agreement was observed for the definitions of “de-escalation without omission” and “primary triage scale” (20; 28.6%, and 21; 3%, respectively). The most agreed-upon statements were those requiring healthcare providers to receive training on contagious diseases and calling for providing them with housing if a situation requires them to leave their homes (56; 80%), while the least agreed-upon statements concerned withholding mechanical ventilation from patients (29; 41.4%). Conclusion: During epidemics, health-care workers provide services in unusual, challenging situations. Doing so necessitates support in social, psychological, and professional areas. A decision-making framework is needed that endorses the cultural and religious contexts, as well as the lived experiences of frontline clinicians, including a clear de-escalation plan and a primary triage system during the pandemic.

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