It’s the end of the first week of
the voluntary UK lockdown and the beginning of a strange new world. Perhaps one
of the strangest things of last week was Bob Dylan releasing a new song (the
first since 2012) entitled ‘Murder Most Foul’. It’s almost 17 minutes long. Have a listen to it and see how many famous song titles you can identify as you
do. I’m willing to bet that my friend and colleague Dr Kirsty Fairclough got
all 75 songs right.
It’s a long song, but not as long
as the Prime Minister’s daily Covid19 briefings. Personally, I have been
fascinated by these daily productions. As someone who has a secret anthropologist
hidden deep inside them and desperate to break free, I marvel at the careful use
of words, the stage positioning, the change of podium messaging, the way the protagonists
appear to dutifully write notes as they listen to the questions being asked of
them. It makes for compelling viewing for the socially isolated.
The cynic in me, however, worries
about the quality of questions asked by the reporters at each briefing. I
wonder about the difficulty they have in finding questions to ask that allow them
to be reporters, to challenge and hold others to account. I suspect it’s a tough
choice, between demonstrating solidarity with the message, and giving a voice (often
a dissenting one) to those who don’t have one.
Here is an example. At last Friday’s
briefing the Teflon-coated Marmite Chancellor of the Duchy of Lancaster,
Michael Gove, spoke sincerely of the indiscriminate nature of the coronavirus,
and the fact that our Prime Minister had now tested positive for Covid19. Boris
Johnson had developed symptoms on Thursday and had been tested. Well if that
wasn’t enough to get the reporters going, I don’t know what would. But nothing.
When someone linked the Prime Minister getting tested and the current situation
that front line NHS staff faced in not getting the same test, it didn’t seem a very
convincing challenge. Even when Dr Jenny Harries (Deputy Medical Officer for
England) observed that it depended where you were in terms of the centrality of
your role in relation to the Covid19 response, as to whether you were tested or
not, there was hardly a murmur.
The pressure to test NHS workers
has been growing for a while, and last Friday it was confirmed that certain NHS
staff would start to be tested for coronavirus this weekend. I read one report that
noted Chessington World of Adventures was to be one of these trial testing
sites. Bizarrely, reading this stirred up a memory of my going to the zoo there
when I was much younger, on a Sunday School outing.
The WHO advice has for some time been
to test, test, test, trace and treat. Let’s hope that now the testing has
started, it can be ramped up and match what has been happening in places like
Germany, Singapore, UAE, and South Korea. However, testing can, in some
situations, lead to unintended consequences, sometimes tragically. Readers of
this blog may have seen the sad story of Daniela Trezzi, the 34 year old
Italian nurse who ended her life though suicide last week, after testing positive
for coronavirus. She killed herself out of fear that she was spreading the
virus. I cannot begin to imagine the turmoil she might have been going through,
or the guilt, fear and anxiety she must have been experiencing. The personal
choices she might have felt she was facing in trying to respond to these feelings
must have been unbearable.
Yesterday the number of deaths from
coronavirus surpassed 1,000 in the UK. Over the next 12 weeks, the rate of
deaths is sadly likely to keep rising. Just like China, we are building huge ‘warehouse’
hospitals with thousands of beds in anticipation of the coronavirus surge. However, even with Sir James Dyson on the
case, it’s unlikely there will be enough ventilators to treat people as the coronavirus
surge gains momentum to supply these and other hospitals. As such I think that
that difficult choices over who gets treated and who will be provided with palliative
care will increase along with the numbers of people contacting the coronavirus.
Last week I had three eMeetings with folk from three different organisations,
where we discussed plans for how some of these choices will be made, by whom,
and how supported people might be when such decisions are taken.
Doctors and nurses will have to consider who
might have the best chance of living when there is limited opportunity to
provide the same treatment to everyone? These will be difficult decisions for many
healthcare professionals to take, but take them they will have to.
The focus of our discussions was
almost universally described as tackling the ethical issues involved in taking
such decisions. Indeed, the British Medical Association (BMA) have recently
reissued their ethical guidelines. Interestingly, whilst the BMA makes it clear
that the guidance should apply to all patients regardless of their need, it’s a
very practical guide. Yes, if one looks
closely, its possible to see shades of Aristotle, Kant, Mill and Bentham’s philosophical
thinking around ethics, but it’s mainly the more contemporary ideas of the American
philosophers, Tom Beauchamp and James Childress, who published their famous
book, ‘Principals of Biomedical Ethics’, that underpin the BMA guidance.
Their work introduced what has
become known as the four principals of healthcare ethics: respect for autonomy;
nonmaleficence; beneficence; and justice. I don’t have room to expand upon
these in this blog, but this is what I point my research students to when they
are developing their thinking around the ethical considerations of their study.
In the real world of 2020, I believe that all patients should be given
compassionate and dedicated healthcare. Sadly, there is a legal, professional
and ethical case to prioritise treatment when there are more patients with
needs than the available resources can meet. As a Non-Executive Director,
academic and nurse, I intend to stand shoulder to shoulder with my clinical colleagues
faced with making such decisions. Stronger together.
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