When a ship is sinking, the order was to save children and women first, and at the same time, it was said the captain would sink along with his ship. The situation is similar in Mexico , as the federal government has focused on helping the poor through welfare programs. Now, amid the COVID-1 9 pandemic, there is an ethical dilemma : if the healthcare system collapses, doctors might privilege younger patients over the elderly .
It would be logical to treat all patients and the only criteria were the order in which patients arrived but even during normal days in the ER , doctors establish who is a priority based on their case. For example, those who are wounded are treated immediately and those who have a fever or are in pain have to wait longer to be treated. Therefore, although prioritizing a patient over others might be an act of discrimination but it is necessary.
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However, it is difficult for healthcare workers to make decisions when there is a lack of equipment such as ventilators . Who to prioritize? The best option would be to have a bioethics guide, a protocol to follow during critical times, as it could be the case of Mexico soon as it is expected that the health system could be overcrowded when the COVID-19 pandemic reaches its peak.
Nevertheless, the first version of the bioethics guide was perhaps not the best, as it stated that health workers must privilege young patients over older patients or those with more serious conditions.
After the backlash, the General Health Council issued a new bioethics guideline where certain patients are not prioritized over others, and criteria that include age or a preexisting condition are no longer included. Instead, the new version includes a physiological evaluation system based on international systems.
There are sensible ways to announce complex decisions that will be made inside the intensive care units but the measures should be discussed and shared with transparency so that society understands that the goal is to save as many lives as possible.
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