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National health system cuts and triage decisions during the COVID-19 pandemic in Italy and Spain: ethical implications
  1. Maurizio P Faggioni1,
  2. Fermín Jesús González-Melado2,
  3. Maria Luisa Di Pietro3
  1. 1 Moral Theology and Bioethics, Alphonsian Academy, Rome, Lazio
  2. 2 Moral Theology and Bioethics, High Center for Theological Studies, Badajoz, Spain
  3. 3 Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
  1. Correspondence to Dr Fermín Jesús González-Melado, Moral Theology and Bioethics, High Center for Theological Studies, Badajoz, Spain; ferminjgm{at}


In this paper, we analyse the most important documents establishing the criteria for the treatment and exclusion of COVID-19 patients, especially in regard to the giving of respiratory support, in Italy and Spain. These documents reflect a tension that stems from limited healthcare resources which are insufficient to save lives that, under normal conditions, could have been saved, or at least could have received the best possible treatment. First, we analyse the healthcare systems of these two countries before the spread of the virus, both of which have seen decreases in the number of intensive care beds and have been marked by financial cuts during the last ten years. It is a fact that a greater number of people, especially those over 70 years of age, have been left without respiratory support treatment, and therefore, there have been a greater number of deaths. It is also a fact that there has been a higher infection rate among healthcare professionals due to the delay in the management of protective measures and the inability to provide adequate care for those in nursing homes, as recognised by WHO. In the context of this health emergency, healthcare professionals have suffered a real ‘moral distress’ because, knowing first-hand the causes of the limitation of resources, they have had to put triage protocols into practice. Finally, we set forth a series of concrete ethical proposals with which to face the successive waves of COVID-19 infection, as well as other future pandemics.

  • allocation of health care resources
  • health care economics
  • public health ethics
  • right to healthcare
  • public policy

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  • Contributors All authors have contributed equally.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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