Coronavirus has hospitals updating plans to decide who gets lifesaving treatment
WASHINGTON (SBG) — The threat of coronavirus overwhelming the health system, requiring the rationing of crucial resources like ventilators, has hospitals and institutions nationwide creating and updating plans for how to determine who gets life-saving treatment.
A YouTube video that's racked up nearly a million hits is a testament to just how dire the situation could become for hospitals overwhelmed by coronavirus patients. The video, posted by a Detroit emergency physician, is a tutorial for other doctors on how to modify one ventilator to make it work for as many as four patients.
The need for that type of crisis creativity is something most hospitals in the United States had hoped to avoid. And it seems they have so far, with the COVID-19 curve showing signs of flattening in some cities. The situation in the American health care system has not yet required the rationing of ventilators, at least according to Vice President Mike Pence, who said in an April 13th briefing, "No one who has required a ventilator has been denied a ventilator in the United States of America," stated Vice President Pence during the administration's April 13th coronavirus briefing.
Still this pandemic has forced many hospitals to plan for the worst-case scenario, mapping out how they'll carry out rationing out critical resources. Dr. Barron Lerner, a professor of medicine at NYU Langone Medical Center in New York explained, "This is a plan for a super-duper emergency where there’s potentially an enormous demand and not enough machines."
Lerner, who's also a medical ethicist, spoke remotely with Spotlight on America about the guidelines that help hospitals make ethical decisions in a worst-case scenario like the coronavirus pandemic. According to the Center for Public Integrity, which tracked policies, at least 25 states have guidelines to help if it comes to rationing. Those states include New York, Pennsylvania, Massachusetts, Colorado and Washington state.
Those guidelines vary depending on where you live. Spotlight on America has learned some state guidelines, including the ones created in New York, haven't been updated in years. But Dr. Lerner says they still set a basic framework for how to make unthinkable decisions in the most ethical way possible.
"We’re just hoping we don't have to do this very much because it’s going to be unbelievably difficult for patients and families to hear this. It's just so sad," explained Dr. Barron Lerner about the potential for delivering news about rationed resources to COVID-19 patients.
Ultimately, Dr. Lerner says it’s doctors on the front lines who would have to relay news about rationed resources, delivering heartbreaking news to potentially to patients who are isolated and alone. But he says they shouldn’t make decisions at the bedside. Instead, New York’s guidelines say hospitals should rely on triage committees. Those committees, according to Lerner, could be made up of clinicians, ethicists, nurses, chaplains and others who can objectively weigh who should get resources. A team of health care experts advocated for the use of this type of committee in the New England Journal of Medicine just weeks ago.
"I think it would be unbelievably difficult for doctors immediately taking care of patients to have to make that decision," Lerner said. "It's hard enough for doctors to know that one of their patients is potentially being denied a lifesaving intervention. It’s even worse for them to be the one that makes the decision."
Medical ethicists writing about the issue seem to agree decisions about rationing life-saving interventions like ventilators should be made blind, without knowing specifics of the patient’s identity, wealth or status. Depending on where you live, there are formulas already in use that assign scores to everything from age, existing medical problems and current health condition to determine who should have priority. There's robust concern from some groups that some populations of people, including the disabled or elderly, could be at a disadvantage in a rationing scenario.
In some locations, Lerner told us, the patient's status as a health care professional is also up for consideration when and if rationing decisions are made. "If you save their life and they go back to work, they will save more lives. So that’s one of those ethical judgments I think individual institutions will probably make on their own," Lerner said. "We would say who is most likely going to get off a ventilator, be well enough and live for a long period of time afterward. That would be the person at the top of the list."