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Best interests versus resource allocation: could COVID-19 cloud decision-making for the cognitively impaired?
  1. Jordan A Parsons,
  2. Harleen Kaur Johal
  1. Centre for Ethics in Medicine, Bristol Medical School, University of Bristol, Bristol, UK
  1. Correspondence to Jordan A Parsons, Centre for Ethics in Medicine, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK; jordan.parsons{at}


The COVID-19 pandemic is putting the NHS under unprecedented pressure, requiring clinicians to make uncomfortable decisions they would not ordinarily face. These decisions revolve primarily around intensive care and whether a patient should undergo invasive ventilation. Certain vulnerable populations have featured in the media as falling victim to an increasingly utilitarian response to the pandemic—primarily those of advanced years or with serious existing health conditions. Another vulnerable population potentially at risk is those who lack the capacity to make their own care decisions. Owing to the pandemic, there are increased practical and normative challenges to following the requirements of the Mental Capacity Act 2005. Both capacity assessments and best interests decisions may prove more difficult in the current situation. This may create a more paternalistic situation in decisions about the care of the cognitively impaired which is at risk of taking on a utilitarian focus. We look to these issues and consider whether there is a risk of patients who lack capacity to make their own care decisions being short-changed.

  • allocation of health care resources
  • capacity
  • clinical ethics
  • decision-making

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  • Twitter @Jordan_Parsons_, @harleen_johal

  • Contributors JAP conceived the idea. Both authors contributed equally to research, planning and drafting. Both authors read and approved the final manuscript.

  • Funding This study was funded by Wellcome Trust (209841/Z/17/Z).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement There are no data in this work.

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