The doctor-patient relationship in times of pandemic between care needs and scarce resources: challenges and opportunities

On April 29-30, 2021 the University of Milan will host an online Conference within the Seed Project “See, Order, Communicate, Process: tools for a new doctor-patient relationship model” and the Jean Monnet Module “Law and Policies for Social Rights Protection in Europe”.

Conference Topic

As we have already heard so many times during the pandemic, Covid-19 poses several unprecedent challenges to medical practice, to medical decision-making process and to the doctor-patient relationship. The available resources in medical settings, especially the limited resources within intensive care units, cannot often assure medical cares to all patients and doctors have been called upon to make tragic choices, deciding which patients were worth treating and which were not. 

In Italy, for examples, because of the imbalance between the clinical needs of the Covid-19 patients and the availability of medical resources, the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) has drawn up Recommendations of clinical ethics for admission to intensive care treatments and their suspension. SIAARTI has suggested some criteria (based on the principles of clinical appropriateness, proportionality of care, and distributive justice) according to which make these tragic choices. As well as in Italy, in many other countries, professional bodies offered guidance on how these decisions should be made (Royal College of Physicians, Ethical dimensions of COVID-19 for frontline staff; British Medical Association,COVID-19: ethical issues; American Medical Association, COVID-19 Ethics Guidance etc.).

Even if this is not a new dilemma in medical practice, the spread and the worsening of the pandemic has sparked the debate. Which are the ethical and legal principles that can guide the allocation of scarce health-care resources? What is the role of legal rules (hard-law and soft-law) in regulating these choices? How can these decisions affect the doctor-patient relationship? How to reconcile the individual and the public health dimensions? Can algorithms be considered ‘objective’ decision-making tools? Can the pandemic be regarded as an opportunity to improve the bioethical and bio-juridical paradigms governing the doctor-patient relationship?