Abstract:
The COVID-19 pandemic has brought discussions around the appropriate and fair rationing of scare resources to the forefront. This is of
special importance in a country such as South Africa (SA), where scarce resources interface with high levels of need. A large proportion
of the SA population has risk factors associated with worse COVID-19 outcomes. Many people are also potentially medically and socially
vulnerable secondary to the high levels of infection with HIV and tuberculosis (TB) in the country. This is the second of two articles.
The first examined the clinical evidence regarding the inclusion of HIV and TB as comorbidities relevant to intensive care unit (ICU)
admission triage criteria. Given the fact that patients with HIV or TB may potentially be excluded from admission to an ICU on the basis
of an assumption of lack of clinical suitability for critical care, in this article we explore the ethicolegal implications of limiting ICU access
of persons living with HIV or TB. We argue that all allocation and rationing decisions must be in terms of SA law, which prohibits unfair
discrimination. In addition, ethical decision-making demands accurate and evidence-based strategies for the fair distribution of limited
resources. Rationing decisions and processes should be fair and based on visible and consistent criteria that can be subjected to objective
scrutiny, with the ultimate aim of ensuring accountability, equity and fairness.
