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Fallacy of the last bed dilemma
  1. Luca Valera1,
  2. María A. Carrasco2,
  3. Ricardo Castro3
  1. 1 Bioethics Centre, Pontificia Universidad Catolica de Chile, Santiago, Chile
  2. 2 Bioethics Centre, Department of Philosophy, Pontificia Universidad Catolica de Chile, Santiago, Chile
  3. 3 Department of Intensive Care Medicine, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
  1. Correspondence to Professor Luca Valera, Bioethics Centre, Pontificia Universidad Catolica de Chile, Santiago 8331150, Chile; luvalera{at}


The COVID-19 pandemic highlights the relevance of adequate decision making at both public health and healthcare levels. A bioethical response to the demand for medical care, supplies and access to critical care is needed. Ethically sound strategies are required for the allocation of increasingly scarce resources, such as rationing critical care beds. In this regard, it is worth mentioning the so-called ‘last bed dilemma’. In this paper, we examine this dilemma, pointing out the main criteria used to solve it and argue that we cannot face these ethical issues as though they are only a dilemma. A more complex ethical view regarding the care of COVID-19 patients that is focused on proportional and ordinary treatments is required. Furthermore, discussions and forward planning are essential because deliberation becomes extremely complex during an emergency and the physicians’ sense of responsibility may be increased if it is faced only as a moral dilemma.

  • end of life care
  • COVID-19
  • resource allocation
  • allocation of health care resources
  • moral and religious aspects

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  • Contributors All the authors equally participated in the paper. LV is mainly responsible for sections I, IV and V. MAC is mainly responsible for sections II and III. RC is responsible for the medical details, figure and clinical cases.

  • 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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