CRITCON-Pandemic levels: A stepwise ethical approach to clinician responsibility

Dan Harvey; Dale Gardiner; Andrew McGee; Thearina DeBeer; David Shaw

doi:10.1177/1751143720950542

CRITCON-Pandemic levels: A stepwise ethical approach to clinician responsibility

J Intensive Care Soc. 2022 Feb;23(1):70-77. doi: 10.1177/1751143720950542. Epub 2020 Aug 27.

Authors

Dan Harvey¹, Dale Gardiner¹, Andrew McGee², Thearina DeBeer¹, David Shaw^{3

4}

Affiliations

¹ Nottingham University Hospitals NHS Trust, Nottingham, UK.
² Faculty of Law, Queensland University of Technology, Brisbane, Australia.
³ Universitat Basel Institut fur Bio-und Medizinethik, Basel, Switzerland.
⁴ Care and Public Health Research Institute, Maastricht University, Netherlands.

Abstract

CRITCON-Pandemic levels with an associated operational responsibility matrix were recently published by the Intensive Care Society as a modification to Winter Flu CRITCON levels, to better account for differences between a winter flu surge in critical care activity and the capacity challenges of the COVID-19 pandemic. In this paper, we propose an expansion and explanation of the operational matrix to suggest a stepwise ethical approach to clinician responsibility. We propose and outline the main ethical risks created at each level and discuss how those risks can be mitigated through a balanced application of the predominant ethical principle which in turn provides practical guidance to clinician responsibility. We thus seek to specify the ethical and legal principles that should be used in applying the operational matrix, and what the practical effects could be.

Keywords: COVID 19; critical care; ethics; intensive care; triage.