Ethical Issues
Not only should the planning for the management of a pandemic focus on trying to reduce the spread of the virus or on treating the sick, but also on providing ethical considerations that allow establishing certain limits16. In this sense, and in a situation like the one experienced in Spain beginning in March 2020, it is totally necessary to ask certain questions such as:
The aforementioned issues have sparked enormous controversy in Spain, not only on a medical level but also among public opinion and the media, and the contest has finally moved to the political scene. The controversy has focused on patients older than 75-80 years, many of whom were not transferred from their retirement homes or residences to hospitals or once admitted to hospital centers, did not have access to critical care beds or ECMO support. The controversy is not over, and it even seems inevitable that it will have judicial ramifications.
The other major ethical concern that involves us, as cardiac surgeons, is the need to continue our surgeries in the event of a pandemic, as a shortage of beds and respirators is expected in the Intensive Care units. In this scenario, it seems reasonable to cancel elective surgeries, but not urgent ones, since the decision to reserve a bed for a critically ill COVID-19 patient and not offer cardiac surgery to a potentially more recoverable patient is a truly conflicting, complicated decision. In the COVID-19 era, the “Heart Team” perhaps becomes more essential and can serve to face certain indications with a more open mind or a more groundbreaking approach that facilitates controversial decision-making by a team and not by one individual.
Focusing on ethical considerations regarding ECMO support during the pandemic, we believe it is essential to keep at least the following points in mind: