Ethical Dilemmas in the Therapeutic Management of Patients with Sars-Cov-2 Infection

Abstract

The new coronavirus pandemic has brought into the light-on top of the strain it put on the medical services around the world-a variety of ethical issues in relation to how the treatment is being administered to the patients. Understanding the priority of treating COVID-19 patients, we still ask ourselves how effective these antiviral/immunomodulatory molecules are recommended by national/international protocols and which is the benefit/risk ratio in different categories of patients. To solve these dilemmas, we present the case of a 36-year-old patient, admitted to our clinic in April 2020, with mild symptomatic SARS-CoV-2 infection. Given the suggestive clinical and paraclinical elements, we recommended treatment with lopinavir/ ritonavir according to national protocol, and we explained to patient the benefits of this treatment, as well as the possible side effects. The patient refused this treatment, but later accepted an alternative therapy, hydroxychloroquine. The evolution of clinical and paraclinical parameters allowed the patient to be discharged after 19 days. This apparently simple and solvable medical case becomes complicated when the patient complained about the violation of her rights and of certain articles from deontological code. Beyond the elements of subjectivism, it is necessary an ethical approach of this problem. After 9 months of pandemics, we can say that some anti-COVID -19 therapies have proven a practical effectiveness and others have been partially invalidated by clinical trials and removed from the guidelines, but can we say every information regarding anti - SARS-CoV-2 medication is absolutely clear or that ethical aspects are solved?