CHEST Guidelines-Rule-of-Double-Effect-and-Utilitarianism

Rule-of-Double-Effect-and-Utilitarianism_chest

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The document contains two letters in response to prior articles published in the journal CHEST, centered around issues in treating COVID-19 and ethical considerations in healthcare.<br /><br />In the first correspondence, authors Tacquard et al. respond to Paez et al., discussing their study on the effects of high-dose prophylactic anticoagulation (HPA) in critically ill COVID-19 patients. They address points about the incidence of thrombotic complications and the bleeding risks associated with HPA. The authors assert that their reported incidences align with previous studies but note the challenges in standardizing the data due to varying local screening protocols and evolving patient management strategies. They emphasize that changes in patient co-morbidities and treatments, like corticosteroids and anti-inflammatory drugs, may impact thrombotic risks, affecting the benefits of HPA. Moreover, the timing of HPA administration is crucial, as its advantages may diminish once inflammation decreases, potentially raising bleeding risks. The authors regret the scarcity of studies detailing simultaneous thrombotic and bleeding events, highlighting the complexity in evaluating HPA's effects on micro-thrombosis and mortality.<br /><br />In the second response, Yip et al. critique Bishop and Eberl's use of the rule of double-effect (RDE) to justify the withdrawal and reallocation of life-sustaining treatment (LST) during crises. They argue against the interpretation that withdrawal, leading to a patient's death, is an indirect means to save another, pointing out that the act might not always align with utilitarian principles. In their follow-up, Bishop and Eberl defend their stance, clarifying that a patient's death post-withdrawal is an outcome of their condition, not a direct intention or causal means toward reallocating resources for another. They compare this to military strategy, emphasizing decision-making for the greater good in medical and crisis settings, aligning their argument within a broader ethical framework rather than purely utilitarian reasoning.

Keywords

COVID-19 treatment

high-dose prophylactic anticoagulation

thrombotic complications

bleeding risks

patient co-morbidities

rule of double-effect

life-sustaining treatment

ethical considerations

resource allocation

utilitarian principles