Who should doctors let die in a pandemic?

THL · 05-06-2008, 12:47 PM

Quote:

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.

Those most likely to survive
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.''

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THL · 05-06-2008, 12:52 PM

So after all the older folks get killed off and they finish up with the people who have dementia and other severe illnesses they are going to have to start choosing from the rest of us.

So who will be the next to go? Politicians? Those of us that work for the big bad oil companies? Walmart employees?

My vote goes for Brittany Spears.

gunnut · 05-06-2008, 13:02 PM

They're trying to conserve resources should something terrible happen.

We do that in our daily lives. We buy things with the most value to us for the least price possible to maximize efficiency.

Would you rather have resources that could have saved 2 healthy, young adults, going toward saving an elderly who probably would have only lived an extra 7 years?

Ryan Bailey · 05-06-2008, 13:23 PM

Your problem exposes a type of lurking danger in the institution of social congregation.

The hermit has an advantage in such a pandemic.

Bob Jones · 05-07-2008, 09:48 AM

Rock stars would be my choice, waste of space the lot em

omon · 05-07-2008, 09:51 AM

i dissagree, age should not be a primary factor, should be mainly on a factor of their usefullness to everyone around, i,d sure wouldn,t want to save some 18yo crackhead, or criminal, at an expence of some 65+ y. o. dude, or lady, (a doctor, or an inventor) who will be much more usefull whititn their 5-7 years they got left, than a crackhead in his entire lifespan.

**Officer of Engineers** · 05-07-2008, 10:13 AM

This has always been the case. Those who are going to die no matter what you do - make them comfortable. Those who need immediate treatment. And those who can wait.

Ray · 05-07-2008, 10:39 AM

Rather well summed up by the Colonel.

However, if I were the conspiracy theory addict, I would say that it is conspiracy to save money by reducing the unproductive burden (old chaps) to the coffers; after all, pensions have to be paid!!

Blademaster · 05-07-2008, 11:15 AM

This is just formalizing the true and tried method of triage. You separate the ones that have a good chance of living from those who has no chance of living so you can administer the necessary care first to ensure survival and make the rest comfortable. Then you separate those who can wait from those who cannot wait and then administer the necessary care first.

Mobbme · 05-07-2008, 11:23 AM

Quote:

Originally Posted by Bob Jones

Rock stars would be my choice, waste of space the lot em

rofl

Mobbme · 05-07-2008, 11:24 AM

Quote:

Originally Posted by Blademaster

This is just formalizing the true and tried method of triage. You separate the ones that have a good chance of living from those who has no chance of living so you can administer the necessary care first to ensure survival and make the rest comfortable. Then you separate those who can wait from those who cannot wait and then administer the necessary care first.

Exactly. Well said.

Mobbme · 05-07-2008, 11:28 AM

Quote:

Originally Posted by omon

i dissagree, age should not be a primary factor, should be mainly on a factor of their usefullness to everyone around, i,d sure wouldn,t want to save some 18yo crackhead, or criminal, at an expence of some 65+ y. o. dude, or lady, (a doctor, or an inventor) who will be much more usefull whititn their 5-7 years they got left, than a crackhead in his entire lifespan.

As much as I dislike people who take drugs, an 18 year old crack head can get rehabilitated and make something of him or herself. I'm sure the lot of successful people must've included previous drug users. Doing crack vs the coke is a big difference to some, but for me they're both dangerous drugs. But I agree, age should not be the primary reason.

Debbie · 05-07-2008, 15:04 PM

I am thinking Soylent Green for some reason

05-06-2008, 13:02 PM	#3 (permalink)
gunnut *Senior Contributor* Join Date: 01-27-06 Location: DPRK, Democratik People's Republik of Kalifornia Posts: 9,284 Country:	They're trying to conserve resources should something terrible happen. We do that in our daily lives. We buy things with the most value to us for the least price possible to maximize efficiency. Would you rather have resources that could have saved 2 healthy, young adults, going toward saving an elderly who probably would have only lived an extra 7 years? __________________ "Only Nixon can go to China." -- Old Vulcan proverb.

05-06-2008, 13:23 PM	#4 (permalink)
Ryan Bailey *Military Professional* Join Date: 09-25-07 Location: Megalopolis, US Posts: 140 Country:	Your problem exposes a type of lurking danger in the institution of social congregation. The hermit has an advantage in such a pandemic. __________________ "If we will not be governed by God then we will be ruled by tyrants" -William Penn

05-07-2008, 09:48 AM	#5 (permalink)
Bob Jones Thats, Mr Jones to you *Military Professional* Join Date: 02-11-07 Posts: 316 Country:	Rock stars would be my choice, waste of space the lot em __________________ Ex1 RTR MIB

05-07-2008, 09:51 AM	#6 (permalink)
omon Field mechanik *Senior Contributor* Join Date: 11-01-06 Location: bk Posts: 1,910 Country:	i dissagree, age should not be a primary factor, should be mainly on a factor of their usefullness to everyone around, i,d sure wouldn,t want to save some 18yo crackhead, or criminal, at an expence of some 65+ y. o. dude, or lady, (a doctor, or an inventor) who will be much more usefull whititn their 5-7 years they got left, than a crackhead in his entire lifespan. __________________ "Democracy is two wolves and a lamb voting on what to have for lunch. Liberty is a well-armed lamb contesting the vote!" B. Franklin

05-07-2008, 10:13 AM	#7 (permalink)
Officer of Engineers Moderator Scotch taster Join Date: 08-06-03 Posts: 15,838 Country:	This has always been the case. Those who are going to die no matter what you do - make them comfortable. Those who need immediate treatment. And those who can wait. __________________ Chimo

05-06-2008, 12:52 PM	#2 (permalink)
THL *Senior Contributor* Join Date: 06-23-05 Location: 35 minutes outside Chicago (please don't refer to it as "Chi-Town"...that's annoying) Posts: 5,690 Country:	So after all the older folks get killed off and they finish up with the people who have dementia and other severe illnesses they are going to have to start choosing from the rest of us. So who will be the next to go? Politicians? Those of us that work for the big bad oil companies? Walmart employees? My vote goes for Brittany Spears.

05-07-2008, 10:39 AM	#8 (permalink)
Ray Postmaster General *Military Professional* Join Date: 08-20-03 Posts: 26,037 Country:	Rather well summed up by the Colonel. However, if I were the conspiracy theory addict, I would say that it is conspiracy to save money by reducing the unproductive burden (old chaps) to the coffers; after all, pensions have to be paid!! __________________ "Some have learnt many Tricks of sly Evasion, Instead of Truth they use Equivocation, And eke it out with mental Reservation, Which is to good Men an Abomination." I don't have to attend every argument I'm invited to. HAKUNA MATATA

05-07-2008, 11:15 AM	#9 (permalink)
Blademaster Military Enthusiast *Senior Contributor* Join Date: 08-15-03 Posts: 3,036	This is just formalizing the true and tried method of triage. You separate the ones that have a good chance of living from those who has no chance of living so you can administer the necessary care first to ensure survival and make the rest comfortable. Then you separate those who can wait from those who cannot wait and then administer the necessary care first.

05-07-2008, 15:04 PM	#13 (permalink)
Debbie WAB Cautioner of Poo *Senior Contributor* Join Date: 11-20-06 Location: Wisconsin Posts: 3,382 Country:	I am thinking Soylent Green for some reason __________________ And I close my eyes, and I kiss that frog. Each time finding the more boys I meet, the more I love my dog ------ More Boys I Meet - Carrie Underwood

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