Who Will Doctors Choose to Let Die in a Pandemic?
The most difficult decision a doctor will have to make should a pandemic hit is who to let die. Recognizing that not all patients can be saved during a disaster of epic proportions, the medical profession will be faced with making the hard choice of who to treat and who will face certain death.
This week an influential group of doctors has come up with a specific list of recommendations for which patients should not be treated, should such a disaster occur. The groups that were specified in the report as being the lowest on the priority list were seriously injured trauma victims, the very elderly, the severely burned, and the patients with severe dementia.
A task force, whose members come from very prestigious medical groups, universities, and the military, compiled the list. The task force also includes members of government agencies such as Centers for Disease Control, Department of Homeland Security, and the Prevention and the Department of Health and Human Services. The guidelines this group compiled are designed as a blueprint for hospitals, "so that everybody will be thinking in the same way" should a pandemic flu or other health disaster come along, said Dr. Asha Devereaux. She is the lead writer on the task force and a critical care specialist.
The idea of this plan is to try and make sure that scarce resources such as medicine, ventilators, nurses, and doctors are used in a objective, uniform way. These recommendations will appear in a report in the May edition of Chest, the medical journal of the American College of Chest Physicians.
"If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing," the report says.
The task force also wrote, to prepare for such an event, the hospitals should designate a triage team with the Godlike task of deciding who will get care and who won’t. Those who will be on the list not to receive care will be at high risk of dying and a slim chance at long-term survival. The recommendations also get more specific as to the criteria they use to choose the people who will not receive care:
People who are over the age of 85
Patients with severe trauma
Patients who were severely burned and are older than 60
Patients with severe mental impairments
Patients with severe chronic diseases
Director of the preparedness and emergency operations office, Dr. Kevin Yeskey, said the report would be among many agencies reviews as part of the efforts to be more prepared. Public health law expert Lawrence Gostin of Georgetown University said the report was an important initiative but also a political and legal minefield. However, these recommendations would probably violate federal laws against age and disability discrimination, Gostin also said. If followed to the letter, such rules could possibly exclude care of the poor and most disadvantaged citizens who suffer from chronic disease, while healthcare rationing will be a must in a mass disaster of this kind. This view could cause some real ethical concerns.
A senior vice president of the American Hospital Association, James Bentley, said that the report would give guidance to the hospitals in shaping up their own plan to be prepared for a disaster even if they don’t follow all of the suggestions. He said that the suggestions in the proposal resemble those of a battlefield approach in which health care will be limited to those that are most likely to survive. Bentley said that this is not the first time a proposal of this approach has been recommended for a pandemic, but it is the most detailed plan he had seen from a professional group.
While the thought of rationing health care is not pleasant, the report could help the public understand that it will be necessary in this type of situation. Devereaux said that compiling the list of qualifications was emotionally draining and difficult for everyone because the members believe it is only a matter of time before such a health disaster hits.
1) Describe the story as it is presented
2) What are the conflicts in the story ?( arguments, debates,
differences of opinion, alternative options under
consideration) Summarize them succinctly.
3) What are the ethical principles that are expressed or implied by
different sides in the conflict ?
4) Analyze the ethical aspects of the conflict, using the graphic
algorithm distributed and the questions raised in the
Framework for Public Health Ethics Analysis
5) End with your personal opinion about the story and your reasons for
The post Health Ethics
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