“We are not in the black crisis of 2020. But some hospitals are starting to creak. To decide who to assign a place in resuscitation, it would be right to also take into account the vaccination”. Everyone remembers him because it was he who assisted Piergiorgio Welby, suffering from ALS, in his choice of end of life. Mario Riccio today is in charge of the Intensive Care of the Casalmaggiore hospital (Cremona) and in an interview with ‘La Repubblica’ he faces a reflection on the logic that must guide difficult choices such as managing the beds in situations of crowded wards. Situations that Riccio, like many resuscitation primaries, experienced during the first dramatic wave of Covid. When there are few places, he explains, “the rule is to give priority to those who are most likely to succeed. But today this criterion takes on paradoxical implications. Today from Covid only those who want to die die. Many of the patients we treat are young, they have passed the the first year of the pandemic to deny Covid and the second to refuse vaccines. Next to them there is a part of vaccinated people with a very advanced age and important risk factors. Giving priority to those who have the most chance to succeed means putting the no vax in front of the vaccinated “. Riccio states that today we are not in a scenario that forces doctors to make choices of this type. “The resources are enough for now, but let’s not delude ourselves that they are infinite. The president of the Order of Doctors of Naples mentioned the possibility of an ethical triage, or black code. To choose who to assign an unfortunately scarce resource”. asks: “What do we say to those waiting to have cancer surgery, that their bed is blocked by a person who did not want to vaccinate? As Mattarella said, getting vaccinated is an ethical duty. In my opinion it should be included in the priority criteria for treatment “. Riccio gives the example of transplants: “A lung will hardly go to a heavy smoker or a liver to an alcoholic. We would also need criteria for Covid”. And he also expresses himself on the problem of the refusal of treatment by some no vax who ended up in intensive care. “The Siaarti, the Italian Society of Anesthesia, on 31 December drafted a document in which it asks us to explain with reasonable insistence the usefulness of some treatments which the patient no vax sometimes opposes, for example intubation. I would have preferred the opposite approach. Waiting, while I try to insist repeatedly in front of a person who did not want to vaccinate for a year, there is perhaps another patient who would rather be saved and from whom I am taking away a opportunities for treatment “.
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