key: cord-0826767-l7xlaylw
authors: Gebbia, Vittorio; Bordonaro, Roberto; Blasi, Livio; Piazza, Dario; Pellegrino, Alessandro; Iacono, Carmelo; Spada, Massimiliano; Tralongo, Paolo; Firenze, Alberto
title: Liability of clinical oncologists and the COVID-19 emergency: between hopes and concerns()
date: 2020-06-09
journal: J Cancer Policy
DOI: 10.1016/j.jcpo.2020.100234
sha: 5430b70161b2d10413c744b4c1774fe9cbc2d05e
doc_id: 826767
cord_uid: l7xlaylw

To contain COVID-19 spread, Italy is under a global lockdown since February 21, 2020, except for health services and food supply. In this scenario, growing apprehension concerning legal consequences is rising among health professionals due to several ethical and legal questions. Even if medical ethicists may approve patients’ prioritization protocols, hospitals and health professionals remain highly exposed to liability. The so-called smart-working may be very useful, but it may harbor potential legal harms for health personnel and patients and safety. Moreover, personal umbrella policies also often exclude liability arising out of the transmission of a communicable disease, especially a pandemic state, is declared. Under the pressure of medical associations, Italian Government political forces have very recently presented an amendment to the recently released ordinances for the COVID-19 emergency aimed to reduce medical liability. Presumably, similar epidemics or other wide-scale similar events may happen again in an unpredictable future. Therefore, more articulated legal regulations are strongly needed starting from lessons learned from this epidemic.

To date, Italy is experiencing a severe outbreak of COVID-19 infection with a largely unexpected death rate [1] . As a consequence, the entire nation is under a global lockdown to contain virus spread since February 21, 2020, except for health services and food supply [2] .

The sharp increase of patients with COVID-19 related severe acute respiratory syndrome (SARS) requiring in a high percentage of cases immediate hospitalization in intensive care units is rapidly saturating the Regional Health System capacity in some areas of the nation [3] . In a few days, many hospitals have generated COVID-19 dedicated units [4] . In this contest, many medical procedures have been shortened by necessity, and patients withheld or transferred with the uncertainty of correct and adequate enforcement of risk management procedures. Due to the reported health risk of cancer patients in China, the Italian Government, and the Italian scientific associations released guidelines for the management of patients affected by solid and hematological tumors [5] . The measures taken include, among others, postponing follow-up visits and "unnecessary and non-urgent" treatments as well as social distancing and visitors limitation in hospitals.

In this scenario, growing apprehension concerning legal consequences is rising among health professionals not only in Italy but also in the USA. In a recent commentary, Cohen and colleagues [6] raise the ethical and legal issue of deciding which patient should be treated in a moment of a shortage of pulmonary ventilators and invoke urgent State Government actions. Even if medical ethicists may approve patients' prioritization protocols, hospitals and health professionals remain exposed to liability. In our opinion, this is not the only legal risk. The so-called smart-working, applied by several non-medical companies, may be very useful, but it may harbor potential legal harms for health personnel and patients' safety. For instance, releasing prescriptions or judging Therefore, more articulated legal regulations are strongly needed starting from lessons learned from this epidemic.

Study concepts: VG; Study design: VG, RB; Data acquisition: VG, DP; Manuscript preparation, editing, and review: All Authors

Not applicable

Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy

Italian Law -Ulteriori disposizioni attuative del decreto-legge 23 febbraio 2020, n. 6, recante misure urgenti in materia di contenimento e gestione dell'emergenza epidemiologica da COVID-19, applicabili sull

Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response

COVID-19 ITALIA -Monitoraggio della situazione n

Rischio infettivo da Coronavirus COVID-19: indicazioni AIOM, COMU, CIPOMO per l'Oncologia n

Potential Legal Liability for Withdrawing or Withholding Ventilators During COVID-19: Assessing the Risks and Identifying Needed Reforms

Italian Law -Disposizioni in materia di sicurezza delle cure e della persona assistita, nonche' in materia di responsabilita' professionale degli esercenti le professioni sanitarie n

none to declare.

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.