Drudge has a story up about a proposed—but not yet implimented—Florida plan to prioritize care in the event of a terrible flu outbreak and resulting severe resource shortage. I just heard Rush Limbaugh call it a death panel. I don’t agree—mostly—and depending on the details.
In thinking about this, we have to keep in mind the legitimate ethical distinction between the prioritization process of triage, and the invidious discrimination of explicit rationing. From the story:
Florida health officials are drawing up guidelines that recommend barring patients with incurable cancer, end-stage multiple sclerosis and other conditions from being admitted to hospitals if the state is overwhelmed by flu cases. The plan, which would guide Florida hospitals on how to ration scarce medical care during a severe flu outbreak, also calls for doctors to remove patients with poor prognoses from ventilators to treat those who have better chances of surviving. That decision would be made by the hospital. The flu causes severe respiratory illnesses in a small percentage of cases, and patients who need ventilators and are deprived of them could die without the breathing assistance the machines provide.
In June, Florida Surgeon General Ana M. Viamonte Ros sent the draft guidelines — which had already undergone a series of internal revisions — to 16 state medical organizations for their feedback. But the state has not yet publicized the guidelines or solicited input from the general public. The Florida Department of Health released a copy of the draft plan at the request of ProPublica, a nonprofit news organization, which provided it to the Sun Sentinel.
Of course, it all depends on the details ultimately promulgated, but let’s take a closer look without judging a plan still being worked out: If more people need ICU care than there are beds, principles of triage permit responders to prioritize who receives admission to the unit, allowing the sickest or most injured who have the best likelihood of recovery to receive priority. The idea isn’t to ration and exclude anyone from treatment, but to determine who gets help first and who later. And the other patients should still be cared for as best as possible.
Thus, if you have five free ICU beds and eight patients who need them—two of which are dying of cancer and six flu patients who are critically ill but who can survive—it is not invidious discrimination to give the sickest five flu patients most likely to recover priority in admission over the one remaining flu patient and the three actively dying cancer patients. But that doesn’t mean these others shouldn’t receive help or that they shouldn’t receive ICU as soon as possible.
However, I think that it would be wrong to force patients already receiving ICU treatment out of the unit. That is a step beyond triage and into discriminatory rationing. I think that for purposes of triage, only those available beds should be counted, not all beds. Otherwise, the process will quickly descend into quality of life judgmentalism, age discrimination, ableism, etc., rather than true triage prioritization based on survivability, and not quality of life.
These are nuanced matters. But guidelines tend to be applied very bluntly in clinical settings. Thus, it really is important that this proposal make a clear distinction between bona fide triage—ethical—and rationing based on discriminatory value judgments of patient moral worth—unethical.
