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Covid-19: National guidelines needed to support medical profession

09 June 2020

Medical Protection is calling for the Health Professions Council of South Africa (HPCSA) to urgently clarify what guidelines healthcare professionals should follow when making decisions about the withholding and withdrawing of treatment during the Covid-19 pandemic.

This call follows a survey finding that many doctors in South Africa are fearful of recrimination if put in the difficult position of having to ration patient treatment.

The Medical Protection survey of doctors across South Africa found that almost one in three respondents (29%) were either concerned or extremely concerned about facing an employer, criminal or HPCSA investigation for making a decision to withhold or withdraw life prolonging treatment such as ventilation.

The findings from the survey, carried out by Medical Protection and Research by Design, are backed up by previous larger survey results, which showed an even higher degree of concern among certain medical specialties. More than half of anaesthetists (52%) and almost half of those working in emergency medicine (45%) were concerned or extremely concerned about facing investigation in the same circumstances.

Despite being faced with this immense challenge, doctors currently have no national guidelines to refer to when making such difficult decisions.

The HPCSA’s booklet 7, entitled Guidelines for the Withholding and Withdrawing of Treatment refers to national criteria that would need to be agreed upon by the expert professional bodies in the relevant speciality, as well as the HPCSA.

However, since the publication of this booklet in 2016, Medical Protection is not aware of any subsequent comment from HPCSA to initiate putting such guidelines in place.

With the death toll from Covid-19 continuing to rise the need for national guidance is more pressing than ever and Medical Protection has written to the HPCSA calling for guidance to support professional decision making in difficult rationing circumstances.

Dr Graham Howarth, Head of Medical Services, Africa, said:

“Medical professionals across South Africa are fearful that should health services be overwhelmed with Covid-19 cases, they may be forced to make difficult decisions on withholding or withdrawing patient treatment.

“That they are being asked to do so without having national guidelines on which to base such decisions only adds to the distress.

“The Critical Care Society of South Africa (CCSSA) has produced guidance to support professional decision making in difficult rationing circumstances.

“Like all ethical guidelines the CCSSA’s are open to debate but well-informed experts have deliberated over them and many will find they provide useful ethical guidance.

“However, with so many fearful of regulatory and criminal recrimination, doctors need clear guidance that is supported by their regulatory body.

“Medical Protection has written to the HPCSA calling on the body to either study the CCSSA guidance and issue a statement in support of the document, or to issue its own guidance outlining its view as regulator.

“It is particularly important that the HPCSA makes its position clear to doctors in scenarios associated with withholding and withdrawing of treatment in respect of Covid-19 patients.

“Agreeing national guidelines will be complex and we do not presume to have all the answers. We do however know that such guidelines are needed in order to enable doctors to focus on their patients with less fear of legal recriminations.”

END

Notes to editors

For press enquiries contact: Mike Bridge at mike.bridge@medicalprotection.org +44(0)7773 573303.

Survey results

The survey was conducted by the independent market research organisation, Research By Design www.researchbydesign.co.uk. It ran from 18 to 29 May and achieved 337 responses from Medical Protection members in South Africa.

The survey asked Medical Protection members “How concerned are you about facing an employer, criminal or registration body investigation for a decision to withdraw or withhold life prolonging treatment such as ventilation?

Sample size

337

Not at all concerned

20%

Somewhat concerned

20%

Concerned

16%

Extremely concerned

13%

Total concerned (concerned and extremely concerned)

29%

Not applicable

30%

The previous survey ran from 28 April to 4 May and achieved 908 responses from Medical Protection members in South Africa. In answer to the same question, the survey found 30% of respondents were concerned or extremely concerned.

Responses to previous survey by specialty:

Anaesthesia

Not at all concerned

17%

Somewhat concerned

22%

Concerned

24%

Extremely concerned

28%

Total concerned (concerned and extremely concerned)

52%

Not applicable

9%

Emergency Medicine

Not at all concerned

25%

Somewhat concerned

25%

Concerned

35%

Extremely concerned

10%

Total concerned (concerned and extremely concerned)

45%

Not applicable

5%

About Medical Protection

Medical Protection is a trading name of The Medical Protection Society Limited (“MPS”). MPS is the world’s leading protection organisation for doctors, dentists and healthcare professionals. We protect and support the professional interests of more than 300,000 members around the world. Membership provides access to expert advice and support and can also provide, depending on the type of membership required, the right to request indemnity for any complaints or claims arising from professional practice.

Our in-house experts assist with the wide range of legal and ethical problems that arise from professional practice. This can include clinical negligence claims, complaints, medical and dental council inquiries, legal and ethical dilemmas, disciplinary procedures, inquests and fatal accident inquiries.

Our philosophy is to support safe practice in medicine and dentistry by helping to avert problems in the first place. We do this by promoting risk management through our workshops, E-learning, clinical risk assessments, publications, conferences, lectures and presentations.

MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.