Ethical and clinical challenges when providing medical care during the COVID-19 pandemic in Colombia: A global perspective to contribute to the local context/ Problemas ético-clínicos en la atención médica durante la pandemia por COVID-19 en Colombia: una mirada global para un aporte local

Abstract The COVID-19 pandemic has posed many challenges, particularly for health systems, which may be forced to ration the resources available to treat patients with this disease. With its ethical implications, this decision forces health care institutions to choose, among patients with similar vital needs, who will receive the scarce available life support resources in the emergency room or intensive care units based on prognostic criteria. This utilitarian approach aims to achieve the greatest benefit for the largest possible number of patients; however, in Colombia, its implementation faces several obstacles, such as the medical ethos, the instruments used to define the prognosis, the prioritization criteria, the legal-constitutional precepts, and the economic nature of the provision of intensive care services in the country. This article aims to reflect on these aspects and propose a model for patient prioritization based on the creation of multidisciplinary teams that make decisions within a transparent, humane, plural, impartial, equitable, and fair methodological framework. In the context of the current pandemic, these multidisciplinary teams should be guided by four ethical-clinical principles: (a) treat all persons equally, (b) prioritize patients with the worst condition, (c) maximize the benefits that can be obtained from the scarce resources available and (d) preferably select patients with instrumental value. If these four principles are followed, the guidelines drawn up by the Colombian Government concerning the care of COVID-19 patients would be fulfilled within a context of ethical medical autonomy and scientific and professional practice determined by a utilitarian perspective.