Fallacy of the last bed dilemma

Abstract

The COVID-19 pandemic highlights the relevance of adequate decision making at both public health and healthcare levels. A bioethical response to the demand for medical care, supplies and access to critical care is needed. Ethically sound strategies are required for the allocation of increasingly scarce resources, such as rationing critical care beds. In this regard, it is worth mentioning the so-called ‘last bed dilemma’. In this paper, we examine this dilemma, pointing out the main criteria used to solve it and argue that we cannot face these ethical issues as though they are only a dilemma. A more complex ethical view regarding the care of COVID-19 patients that is focused on proportional and ordinary treatments is required. Furthermore, discussions and forward planning are essential because deliberation becomes extremely complex during an emergency and the physicians’ sense of responsibility may be increased if it is faced only as a moral dilemma.

Description and Analysis of Research on Death and Dying during the COVID-19 Pandemic, Published in Nursing Journals Indexed in SCOPUS

“…Bradford’s law is a useful tool for analyzing the distribution of information, as well as to better understand its structure and how the different aspects of a topic are related to one another. Taking this into account, the present analysis established that, of the 71 journals reported, the Journal of Pain and Symptom Management (Q1) with 11 publications [ 57 , 62 , 65 , 70 , 77 , 81 , 87 , 99 , 103 , 109 , 124 ], the Journal of Palliative Medicine (Q2) with 10 [ 59 , 71 , 89 , 91 , 93 , 96 , 98 , 131 , 148 ], the Journal of Religion and Health (not JCR) with 7 [ 58 , 63 , 67 , 78 , 107 , 112 , 118 ], Nursing Ethics (Q1) with 6 [ 39 , 56 , 69 , 73 , 75 , 104 ], Journal of Medical Ethics (Q1) with 4 [ 53 , 100 , 102 , 106 ] and BMJ Supportive and Palliative Care (not JCR) with 3 publications [ 68 , 85 , 97 ] were the central sources, with accounting for only 8.5% of the total. See Figure 1 .…”

Bioethics and COVID-19: Considering the Social Determinants of Health

“…Even though these issues haven't been largely explored in “traditional” medical ethics, it cannot be said that this is something “absolutely new.” Just think at the “classical ethical paradigm” ( 25 , 26 ). The “ordinary means or treatments” basically depend on geographical and temporal factors, cultural conditions, financial status, psychological condition of the patient, and so forth ( 27 ). Or, when ethically assessing an action, it is known that the circumstances constitute a relevant criterion to define the morality of the act itself.…”