In Practice

Critical care triaging in the shadow of COVID-19: Ethics considerations

J A Singh, K Moodley


Since the World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern, COVID-19 infection and the associated mortality have increased exponentially, globally. South Africa (SA) is no exception. Concerns abound over whether SA’s healthcare system can withstand a demand for care that is disproportionate to current resources, both in the state and private health sectors. While healthcare professionals in SA have become resilient and adept at making difficult decisions in the face of resource limitations, a surge in COVID-19 cases could place a severe strain on the country’s critical care services and necessitate unprecedented rationing decisions. This could occur at two critical points: access to ventilation, and withdrawal of intensive care in non- responsive or deteriorating cases. The ethical dimensions of decision-making at both junctures merit urgent consideration.

Authors' affiliations

J A Singh, Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa

K Moodley, Centre for Medical Ethics and Law, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.

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ICU; Intensive care; Rationing; COVID-19; Pandemic; Critical care; Ventilation; Scarce resources; Guidance framework; Ethics; Governance

Cite this article

South African Medical Journal 2020;110(5):355-359. DOI:10.7196/SAMJ.2020.v110i5.14778

Article History

Date submitted: 2020-04-16
Date published: 2020-04-16

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