![]() This simply stated principle supports several moral rules – do not kill, do not cause pain or suffering, do not incapacitate, do not cause offense, and do not deprive others of the goods of life. Nonmaleficence is the obligation of a physician not to harm the patient. However, complying with these standards, it should be understood, may not always fulfill the moral norms as the codes have “often appeared to protect the profession’s interests more than to offer a broad and impartial moral viewpoint or to address issues of importance to patients and society”. ![]() To reduce the vagueness of “accepted role,” physician organizations (local, state, and national) have codified their standards. ![]() A pertinent example of particular morality is the physician’s “accepted role” to provide competent and trustworthy service to their patients. Particular morality refers to norms that bind groups because of their culture, religion, profession and include responsibilities, ideals, professional standards, and so on. Some moral norms for right conduct are common to human kind as they transcend cultures, regions, religions, and other group identities and constitute common morality (e.g., not to kill, or harm, or cause suffering to others, not to steal, not to punish the innocent, to be truthful, to obey the law, to nurture the young and dependent, to help the suffering, and rescue those in danger). Normative ethics attempts to answer the question, “Which general moral norms for the guidance and evaluation of conduct should we accept, and why?”. All rights reserved.Ethics is a broad term that covers the study of the nature of morals and the specific moral choices to be made. Published by Oxford University Press on behalf of the British Geriatrics Society. Given that COVID-19 is here to stay, these conversations aimed at achieving goal-cordant care must become a new clinical norm.ĬOVID-19 critical care goals of care older adults triaging care. During these dialogues, physicians must truthfully convey the emergent clinical reality, discern the older person's therapeutic goals and discuss the feasibility of achieving them. By identifying the robust older people who may benefit from critical care, clinicians should proceed to elicit his values and preferences that would determine the treatment most aligned with his best interest. Survival will also need to be weighed against burden of treatment, as well as longer term functional deficits and quality-of-life. Instead, decisions must be based on individualised risk-stratification that encompasses evidence-based predictors of adverse outcomes specific to older adults. When deliberating beneficence, physicians should steer away from solely using age-stratified survival probabilities from epidemiological data. ![]() Before applying score-based triage, physicians must first discern if older people will benefit from critical care (beneficence) and second, if he wants critical care (autonomy). Decisions regarding intensive care unit admission are particularly challenging in older people, who are most likely to require critical care, but for whom benefits are most uncertain. ![]() Such an approach will become increasingly untenable as countries flatten their epidemic curves. Relying on triage scores to ration care, while relieving clinicians from making morally distressing decisions under high situational pressure, distracts clinicians from what is essentially deeply humanistic issues entrenched in this protracted public health crisis. At the start of the COVID-19 pandemic, mounting demand overwhelmed critical care surge capacities, triggering implementation of triage protocols to determine ventilator allocation. ![]()
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