Who should MDs let die in a pandemic? Report offers answers

[Woodmonkey]

Who should MDs let die in a pandemic? Report offers answers

Doctors know some patients needing lifesaving care won't get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let die.

Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn't be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

The proposed guidelines are designed to be a blueprint for hospitals "so that everybody will be thinking in the same way" when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical care specialist in San Diego and lead writer of the task force report.

The idea is to try to make sure that scarce resources — including ventilators, medicine and doctors and nurses — are used in a uniform, objective way, task force members said.

Their recommendations appear in a report appearing Monday 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 states.

To prepare, hospitals should designate a triage team with the Godlike task of deciding who will and who won't get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:

_People older than 85.

_Those with severe trauma, which could include critical injuries from car crashes and shootings.

_Severely burned patients older than 60.

_Those with severe mental impairment, which could include advanced Alzheimer's disease.

_Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

Dr. Kevin Yeskey, director of the preparedness and emergency operations office at the Department of Health and Human Services, was on the task force. He said the report would be among many the agency reviews as part of preparedness efforts.

Public health law expert Lawrence Gostin of Georgetown University called the report an important initiative but also "a political minefield and a legal minefield."

The recommendations would probably violate federal laws against age discrimination and disability discrimination, said Gostin, who was not on the task force.

If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said. While health care rationing will be necessary in a mass disaster, "there are some real ethical concerns here."

James Bentley, a senior vice president at American Hospital Association, said the report will give guidance to hospitals in shaping their own preparedness plans even if they don't follow all the suggestions.

He said the proposals resemble a battlefield approach in which limited health care resources are reserved for those most likely to survive.

Bentley said it's not the first time this type of approach has been recommended for a catastrophic pandemic, but that "this is the most detailed one I have seen from a professional group."

While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary, Bentley said.

Devereaux said compiling the list "was emotionally difficult for everyone."

That's partly because members believe it's just a matter of time before such a health care disaster hits, she said.

"You never know," Devereaux said. "SARS took a lot of folks by surprise. We didn't even know it existed."

The Source

[Woodmonkey]

This is a long over-due national discussion. Giving limited resources to some of the categories named does mean that people who could survive in a pandemic won't get the needed care.

[leobold1]

Its called triage. You pick the ones that can wait or who are beyond help.

I just don't like the "guidelines." If you have the guidelines, someone that can be helped can be chosen over someone who doesn't have as good a chance, but is outside a pre-judged list.

[Caldric]

I remember the movie Pearl Harbor (horrible movie really) and when they were bringing in all the wounded there was a doctor with the nurse and he would check the wounded and she would make a mark on the forehead. I forget what the letters were I think it was "C" for critical get them in quck and "T" for terminal make them comfortable to die.

I am not sure if we need a guide book but just have to trust the doctors to know their business. When you have a few thousand wounded and a 500 bed hospital some are going to die and just hope the doc knows what he is doing without a guide book or checklist. We can't hang them out to dry for it either.

It's sort of like having to make laws that state a doctor can stop and help someone who is injured without being sued for doing it. I can't fathom sueing someone who stopped to save your life.

[BrianK]

The article didn't mention if the guidelines would be world wide or only an attempt by our health care professionals at providing for those more likely to survive.

I could envision some pretty horrible consequences if America took steps to preserve anti biotics to stop the pan demic here and the rest of the world wanted that supply.

Being prepared for the worst IMO should involve the rest of the human race.

[Woodmonkey]

I gathered this article was only for inside the US and what would we do when there were more patients than resources.

If we didn't have enough antibiotics for our own citizens, it would be criminal to send them out to the rest of the world, IMO.