What question did this study set out to answer?

To examine ethical dilemmas surrounding patient autonomy, treatment refusal, surrogate decision-making, and resource allocation in an intensive care setting during the COVID-19 pandemic.

August 16, 2026Humanities and Social Sciences CommunicationsOpen Access

Ethical challenges in medical decision-making in ICU settings during the COVID-19 pandemic in China

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Authors

FHFang HeWenzhou Medical University ZLZhebing LinWenzhou Medical University ZLZhisu LiWenzhou Medical University

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Implication

Case-based ethical analysis explores treatment refusal conflicts in a critically ill COVID-19 patient, highlighting that respecting autonomy requires assessing both capacity and authenticity.

Key Points

To examine ethical dilemmas surrounding patient autonomy, treatment refusal, surrogate decision-making, and resource allocation in an intensive care setting during the COVID-19 pandemic.
Conducted a case-based ethical analysis of an 85-year-old COVID-19 patient in mainland China who refused extracorporeal membrane oxygenation during a lucid interval before developing delirium.
Analyzed the interplay among core bioethical principles—autonomy, beneficence, nonmaleficence, and distributive justice—under conditions of resource scarcity and familial pressure.
Demonstrated that mental decision-making capacity alone is insufficient to confirm autonomous refusal without evaluating the authenticity of preferences and external pressures like family expectations and financial strain.
Identified critical tensions between an initial competent treatment refusal, subsequent surrogate demands for aggressive care during delirium, and hospital-level resource constraints.
Highlighted the clinical necessity of structured advance documentation, proactive family communication, and multidisciplinary ethics consultations in end-of-life ICU care.

Cite This Study

He et al. (2026) studied this question.

synapsesocial.com/papers/6a817980f2fb91fc834acae6 https://doi.org/10.1057/s41599-026-08762-z

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Implication

Case-based ethical analysis explores treatment refusal conflicts in a critically ill COVID-19 patient, highlighting that respecting autonomy requires assessing both capacity and authenticity.