Potential Legal Liability for Withdrawing or Withholding Ventilators During COVID-19

Cohen, I. Glenn; Crespo, Andrew M.; White, Douglas B.

doi:10.1001/jama.2020.5442

Cited by 96 publications

(88 citation statements)

References 6 publications

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“…Similar concerns have been previously discussed by policy makers regarding the limited availability of means to appropriately treat patients in different contexts [18].…”

Section: Ethic Concerns and Medical Liabilitysupporting

confidence: 62%

Safety Recommendations and Medical Liability in Ocular Surgery during the COVID-19 Pandemic: An Unsolved Dilemma

Napoli

Nioi

d’Aloja

et al. 2020

JCM

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Ocular surgery is one of the most performed medical procedures in the world. Its limitation or suspension, recursively extended over time, could be associated with a significant increase in the number of blind people worldwide. Indeed, cataract causes more than half of all cases of visual impairment in those countries with limited availability of means for performing eye operations (e.g., Africa or India). In this scenario, the pandemic of coronavirus disease 2019 (COVID-19) quickly resulted in the suspension or sharp reduction of various ophthalmic activities considered non-urgent, including lens replacement surgery or some intraocular injections. Despite the imperative need to continuously practice eye operations to avoid the abovementioned problems, there are currently little-shared and vague recommendations among the various countries on safety in operating rooms (for health care workers and patients) and poor legal protection for surgeons (potentially transmitting the COVID-19 infectious agent). Herein, we individuated and discussed some critical points in safety recommendations and medical liability. A paradigm shift for ocular surgery during the COVID-19 era is now mandatory. While telemedicine has been able to solve some problems in clinical ophthalmology, the lack of adequate health and legal protection for surgeons and patients may result in an excessive reduction in the volume of surgical interventions during a pandemic era and the immediately following period, thus determining inability to ensure health care to all patients.

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“…Similar concerns have been previously discussed by policy makers regarding the limited availability of means to appropriately treat patients in different contexts [18].…”

Section: Ethic Concerns and Medical Liabilitysupporting

confidence: 62%

Safety Recommendations and Medical Liability in Ocular Surgery during the COVID-19 Pandemic: An Unsolved Dilemma

Napoli

Nioi

d’Aloja

et al. 2020

JCM

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“…Health care professionals experience a higher chance of exposure risk and face extreme workloads, moral dilemmas, and rapidly varying working environments but at the same time, they handle societal shifts and emotional stress experienced by patients (52)(53)(54)(55). They are at risk of lower immunity due to long working hours (36).…”

Section: Discussionmentioning

confidence: 99%

COVID-19 pandemic fear and anxiety among healthcare professionals in Pakistan

Saleem

Majeed

Rafique

et al. 2020

Preprint

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During the current pandemic, Pakistan is badly affected. It has exerted great pressure on vigor as well as the psychology of the healthcare professionals. Limited resources, illiteracy, myths, and not following the proper protocol by the general population may have increased the risk for everyone, and anxiety and fear among the frontline healthcare professionals. Anxiety is a common response to any stressful situation and its the fear of the unknown and it may have multiple consequences.In the current study, we attempted to analyze the fear and anxiety among the healthcare professionals of Pakistan. An online questionnaire-based survey was performed using a non-probability snowball sampling technique. The questionnaire was validated and comprised of demographics and 10 questions regarding fear and anxiety as per fear of coronavirus-19 scale (FCV-19S). SPSS 21 was used for data analysis. Data of 404 participants analyzed. A significant difference between gender, age group, and the profession was found (p<0.05). Out of 404 participants, 322 (79.70%) were considered to have high and severe anxiety (p=0.020). Based on the results anxiety was reported higher among the nurses and in females. A significant relationship was observed between fear and anxiety score and the different healthcare professionals with p value< 0.001 (Multilinear regression).Concerning the high occurrence of anxiety and fear among healthcare professionals appropriate psychological/psychiatric intervention necessitates and emphasizes the need to implement urgent measures.

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“…Since the initial identification of SARS-CoV-2 infections in Wuhan, it has been important to identify characteristics beyond China with implications in management [1,2]. Reports describing ICU patients with SARS-CoV-2 out of China are still limited [3,4]. The clinical course of adult inpatients in Wuhan has been reported [5] with a high mortality rate and a risk of death above 90% in presence of high (0.05 ng/ml) procalcitonin (PCT) plasma [5].…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 in Spanish Intensive Care Units: Early experience with 15-day survival in Vitoria

Barrasa

Rello

Tejada

et al. 2020

Anaesthesia Critical Care & Pain Medicine

200

204

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Purpose: Community transmission of SARS-CoV-2 was detected in Spain in February 2020, with 216% intensive care unit (ICU) capacity expanded in Vitoria by March 18 th , 2020. Methods:We identified patients from the two public hospitals in Vitoria who were admitted to ICU with confirmed infection by SARS-CoV-2. Data reported here were available in March 31th, 2020. Mortality was assessed in those who completed 7-days of ICU stay. Results: We identified 48 patients (27 males) with confirmed SARS-CoV-2. Median [interquartile range (IQR)] age of patients was 63 [51-75] years. Symptoms began a median of 7 [5-12] days before ICU admission. The most common comorbidities identified were obesity (n = 48%), arterial hypertension (n = 44%) and chronic lung disease (n = 37%). All patients were admitted by hypoxemic respiratory failure and none received non-invasive mechanical ventilation. Forty-five (94%) underwent intubation, 3 HFNT, 1 (2%) extracorporeal membrane oxygenation (ECMO) and 22 (49%) required prone position. After 15 days, 14/45 (31%) intubated patients died (13% within one week), 10 (22%) were extubated, and 21/45 (47%) underwent mechanical ventilation. Six patients had documented co-infection. Procalcitonin plasma above 0.5 µg/L was associated with 16% vs. 19% (p = 0.78) risk of death after 7 days. Conclusion: This early experience with SARS-CoV-2 in Spain suggests that a strategy of right oxygenation avoiding non-invasive mechanical ventilation was life-saving. Seven-day mortality in SARS-CoV-2 requiring intubation was lower than 15%, with 80% of patients still requiring mechanical ventilation. After 15 days of ICU admission, half of patients remained intubated, whereas one third died. Page 4 of 25 J o u r n a l P r e -p r o o f third were non-survivors. Our clinical observations provide useful insights that can help to improve management and outcomes.

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Potential Legal Liability for Withdrawing or Withholding Ventilators During COVID-19

Cited by 96 publications

References 6 publications

Safety Recommendations and Medical Liability in Ocular Surgery during the COVID-19 Pandemic: An Unsolved Dilemma

Safety Recommendations and Medical Liability in Ocular Surgery during the COVID-19 Pandemic: An Unsolved Dilemma

COVID-19 pandemic fear and anxiety among healthcare professionals in Pakistan

SARS-CoV-2 in Spanish Intensive Care Units: Early experience with 15-day survival in Vitoria

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