Bishops in Mexico, England: Age should not be only gauge for COVID-19 help

Medical workers protest to demand better protective equipment to treat patients with COVID-19 outside a hospital in Ciudad Juarez, Mexico, April 15, 2020. (CNS/Reuters/Jose Luis Gonzalez)

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The Mexican bishops' conference has issued ethical guidelines as the COVID-19 crisis worsens in Mexico and medical staff are potentially forced to make life-and-death decisions on which patients receive treatment, and which ones are denied access to equipment like ventilators.

Similarly, the bishops of England and Wales pleaded for fairness in the possible rationing of health care to coronavirus patients amid rising fears that protective and life-saving equipment is running out.

In both cases, the bishops acknowledged that while tough decisions must be made in the current pandemic, age should not be the only criteria for deciding which patients receive treatment.

The Mexican bishops' guidelines recognized that triage, "the orderly and just classification of patients, according to their chances of survival," is necessary and occurs the world over.

But the bishops warned, "It is foreseeable that in Mexico it will be necessary to carry out patient selection processes in order to assign different types of care. These processes must be carried out by simultaneously taking into account the urgency of the case, the needs that must be addressed and that the resources assigned are as beneficial as possible for the patient."

In an April 20 statement, the bishops of England and Wales said life-or-death decisions, such as a "decision against offering a certain life-prolonging treatment to an individual, must never be a judgment based on the worthwhileness of that person's life, including their age or other social characteristics, but a pragmatic decision about the likelihood of him/her benefiting from the intervention given their medical condition."

"Human value is not a measure of our mental or physical capacity, our societal function, our age, our health or of any other qualitative assessment," said the statement.

The Mexican bishop's guidelines, published April 16, come as Mexico confronts an increasingly serious COVID-19 crisis, which could overwhelm an underfunded and underequipped medical system.

Mexico has confirmed more than 8,200 COVID-19 cases and more than 860 deaths from the disease, the health secretariat reported April 19, though testing has been limited. Hugo Lopez-Gatell, undersecretary of health, has recognized the government could be undercounting cases by a factor of eight.

On April 11, Mexico's General Health Council issued guidelines that many in Mexico interpreted as favoring treatment for the young over the old. On April 16, the council revised it recommendations.

Some observers say the government's guidelines were misrepresented or misunderstood at a time when the Mexican response to COVID-19 has come under criticism and health workers in public hospitals have protested that they lack proper protective equipment.

The English and Welsh bishops called for transparency in the allocation of treatment while noting that the demand on Britain's National Health Service resources "is outstripping supply and those responsible for our care and well-being are facing challenging decisions."

The Mexican bishops' guidelines, which included 10 points, also called for widespread testing, something not occurring in Mexico.

"Omitting the most profound diagnosis possible on the expansion of the epidemic not only is a strategic error, but a moral one: transparency in information that seriously affects the common good must proceed in this manner," they said.

The guidelines also advise "avoiding all actions, whether explicit or covert, which could be euthanistic or entail therapeutic cruelty." Additionally, the bishops called for providing health workers with the proper personal protective equipment, saying the failure to do so "is not ethically justifiable. No one can be forced to risk their health and eventually their life without prudent protection."

In his April 19 homily, Cardinal Carlos Aguiar Retes of Mexico City urged respect for health workers, after stories surfaced of doctors and nurse in uniform suffering harassment on public transport and even having bleach thrown at them.

"I invite you to recognize and value those providing health services and putting themselves at risk. We pray for them," Aguiar Retes said.

"They are true heroes, who in their service make Christ present and express divine mercy to the sick."

This story appears in the Coronavirus feature series. View the full series.

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