Who Should Doctors Let Die In A Pandemic?
CHICAGO — 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.”
(AP) By Lindsey Tanner
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Cold blooded but, I see the logic in it. If shit hits the fan its survival of the fittest.
May 5th, 2008 at 5:36 amAnother reason to become educated, healthy and self reliant.
Brian
May 5th, 2008 at 5:47 am“a political minefield and a legal minefield.”
May 5th, 2008 at 5:55 amThis is why lawyers and politicians should be first on the list to not be treated.Common sense says treat as many as you can as fast as you can.Most of the people they list would take special care and in a pandemic those resources trying to save 1 may cost 10.I am closing in fast on their list of let goes and if by my sacrifice more can be saved then do it.
First, do no harm…
I thought that the whole process of triage was about treating the worst cases first and the rest in order of injury. Those who are dying and without any hope of recovery, you just make comfortable and move on.
If I was a doctor, I couldn’t pass up on any patient. I’d have to treat everyone the same.
May 5th, 2008 at 6:09 amIt could become even worse - deciding who are most important to save.
May 5th, 2008 at 6:21 amMan i would hate to have that responsibility. just imagine having to pass an old lady up because she met that criteria. I couldnt do it
May 5th, 2008 at 6:38 amWho Should Doctors Let Die In A Pandemic? Why the Democrats of course!
May 5th, 2008 at 7:25 amAs for another deadly flu epidemic, it is just a matter of time. The 1918 influenza outbreak generally proved deadly to people under 21. I don’t know how well family members are going to accept watching a loved one (what appears to them) needlessly die if some other catastrophic virus or plague strikes. These days it is hard enough to enact some sort of measure to stop a virus from spreading.
(quarantine) 
May 5th, 2008 at 7:28 amJust had a flashback of Dr. Strangelove, babbling away about deep shaft mines, using reasoning a logic to decide who would be saved and who would die.
I truly hope it does not come to that.
May 5th, 2008 at 7:32 amA bit tongue in cheek but find out if they’re liberal or conservative. X the libs, they’re the ones who let everyone and everything into the country because they’re sooo loving and tolerant.
May 5th, 2008 at 7:40 amsame as military triage, if you have to choose who to save you patch up the guy who’s gonna be more likely to get back to the front lines and kill the enemy.
May 5th, 2008 at 9:34 amtime to pill up one’own reserve of :
http://en.wikipedia.org/wiki/Resveratrol
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I saw that 25 kids died in China with a new virus, at the doors of Beijing it’s call “hand-mouth-leg” disease
May 5th, 2008 at 11:34 am