New guidance on treating patients with Covid-19 has sparked concerns from a care official that decisions will be made based solely on age.
Dr Donald Macaskill, head of Scottish Care, said he is “profoundly concerned” over a document issued by Scotland’s chief medical officer Dr Catherine Calderwood on the ethical advice and support framework for medics.
He said it does not spell out the criteria on which difficult “life and death” decisions will be made.
The updated guidance published on Friday stated: “It is important that the right care be delivered to the right patient at the right time.
“Under normal circumstances, these decisions would be made on the basis of patient choice and anticipated clinical benefit to the patient.
“In the context of increased demand, it may also be important to consider fairness of healthcare distribution within the wider population and how finite resources can be most appropriately used.
“Because of this, there may be some complex or challenging decisions where ethical advice or decision-making support will be useful.”
The document sets out the importance of ethical advice and support groups in individual health boards and on a national level to advise on issues such as “complex decisions around the withdrawal of care” and “challenging decisions” around escalation and planned ceilings of care.
The guidance states: “Patients should be treated as individuals, and not discriminated.”
It continues: “No active steps should be taken to shorten or end the life of an individual, however the appropriate clinical decision may be to withdraw life-prolonging or life-sustaining treatment, or change management to deliver end-of-life care.”
Dr Macaskill told BBC Scotland’s Good Morning Scotland programme: “We’ve got these ethical advice and support groups for our frontline clinicians but what this document does not tell us is the criteria on which these really difficult decisions are going to have to be made.
“My concern is that … rather than on a clear ethical framework, decisions will be made on a basis that is unacceptable.”
He added: “Nothing in this document gives me confidence that we will not be putting our clinicians in a position where they have no option but to decide on the basis of age.”
A Scottish Government spokeswoman said they would be “working hard” with the NHS health boards to ensure resources were available to all.
She added: “We are clear that we expect everyone – including our elderly and very vulnerable patients – to always continue to be treated with dignity by health and social care professionals.
“Our ethical advice and support should be read alongside national decision-making guidance, produced by senior clinical experts, to help make decisions in difficult circumstances.
“It is important that the care people receive is appropriate and will benefit them. Our clinicians frequently make difficult judgments about which treatments will provide the most value for their patients.
“All clinical decisions should continue to be guided by the principles of GMC good medical practice and available evidence.
“There may be a small number of complex situations in which additional ethical advice or decision-making support may be useful for healthcare workers and clinical teams, as well as health boards and senior teams.
“The guidance published on Friday sets out the approach to ensuring that this additional support is accessible to all staff who need it when faced with these challenging circumstances.”