In A Pandemic: Who Should Live and Who Should Die?

Doctors and bioethicists have been mulling how to triage care if the deep ecologists receive the deepest yearning of their hearts and the human race is stricken with a deadly pandemic. In such a case, priorities of care will have to be set, but there is cause for worry that the latest report exploring the issue is creating a “quality of life” value system. From the story:

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.

I understand and appreciate the impetus, but the list itself is worrying:

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.

Triage is designed to prioritize care when there is an acute shortage of resources. It creates a temporary priority line for treatment based on helping the most severely injured or ill who, with proper care, are likely to survive. Triage is definitely not rationing since the ultimate goal is to treat everyone.

It strikes me that the recommendation slips from the former into the latter. After all, who knows what the individual cases will look like if the worst befalls us. For example, if an 86-year-old presents with the illness but appears better able to survive it than a more seriously ill 30 year-old, it would appear that the triage principle would be violated under this recommendation by giving priority to the younger person based on age rather than actual physical conditions of the two patients. If so, this violates triage and amounts to age discrimination. Indeed, given that it would be all too easy to treat the guidelines as rigid rules during scarcity of health resources crises, they could be unintentionally dangerous.

A good and sincere try, but I think we can do better than this.