Who should MDs let die in a pandemic? Report offers answers

[Vic303]

Who should MDs let die in a pandemic? Report offers answers

 

By LINDSEY TANNER, AP Medical Writer 58 minutes ago

 

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."

[Cricket]

It seems harsh, but it makes perfect sense that there has to be some triage framework for a pandemic disaster.

 

The men and women working those emergency rooms and medical disaster centers won’t be in those positions for the money. They will remain at their posts because they really want to save lives. Without a pre-arranged set of guidelines, many of these caring folk could snap from the strain of being forced to “play God” and we could lose them just when we need them the most.

 

[CrabGrassAcres]

When resources are scarce, and that includes personnel and space as well as equipment and supplies; just taking first come first served is also 'playing God' because you have made a decision based more on chance than on intelligent decision. It is reasonable to expect doctors and other health care givers to use the scarce resources to save lives. Just treating the first to arrive means you are allowing some to die who could be saved while using heroic means to try to save the hopeless.

[Jeepers]

I agree with doctors making the decissions. I know it may sound harsh and "playing God" but if it was between me at age 56 (in June) and a younger person in good health other wise, I'd hope they would choose the younger one. The same with my cousin who has kidney disease. She is my age and I love her dearly but between her and a more healthy person, I'd have to choose the other one. I know she would too.

 

Actually, I don't I see it as playing God. It's not like the doctors are giving someone the virus. If they already have the flu, or whatever, I look at it as just desiding who to treat first or letting nature take it's course.

 

Another reason to be proactive about our health and get in the best shape possible. And to have some meds stored at home.

[mommato3boys]

Reading this I had flash backs to the movie Pearl Harbor where she used her tube of lipstick and decided who lived and who died. She had to make a tough choice when it come to her best friend. As harsh and uncaring as it sounds they have the right idea. Only those strong enough to fight will stand a chance to survive. What happens if meds are in short supply? What happens if there is not meds to fit this thing?

 

I am thinking of my own mother here. She is 81, an amputee, she is loosing her hearing, her body is riddled with arthritis, and she is suffering from dementia. As harsh as it sounds I would pray that she would be one of the first to go. If something should happen to us kids who would care for her? Would a nursing home still be available for her? Would there be staff for a nursing home?

 

Although I disagree with the burn victims. I think they need to reevaluate the age. Make it like 50% of their body with 3rd burns or something. I don't think age should be a factor when someone is burned. What kind of life would they have afterwards. Would there still be care still available? Would there still be professionals around to do skin grafs? Would they be prone to infections the rest of their life? Would their skin be so delicate that just a tiny bump would cause a skin tear, that not only would lead to possible bleeding be infection to set in? No burn victims need a different scale to go by.

 

When I read something like this I have flash backs to when hubby was in college in the panhandle of Florida. There is a small community hospital there and right next to it is a nursing home and across the street is an assisted living facility.

 

Well there was a bad case of the stomach flu went around one winter. They almost had to close the elementry school because so many children were out sick. Parents went in on a Saturday and helped the teachers and staff bleach the school. We washed walls, men carried desk out side and used power washers, we scrubbed floors. We all wore mask and gloves. Most of us burned our clothes when we got home. It was horrible.

 

Then disaster struck again. It hit the nursing home. I will never forget that horrible week. I was a unit secretary at the time and it was my weekend, which meant I worked Friday through Monday. We lost six people that weekend all from the nursing home. We went through the IV fluids like candy. I remember we ran out of jello and applesauce, I went up to the Piggly Wiggly and got all of their jello, popsicles and applesauce then hit the IGA on the way back and did the same thing. Hubby made a run to Dothan and Chipley and got more. An off duty nurse went to Sam's in Dothan and Panama City and wiped them out. We had every on call CNA and Nurse working. We called all laundry staff back in. It got to the point where the doctors were just going next door and treating people in the nursing home instead of bringing them across the drive. We ran out of sheets and had to rent some from a laundry company. The laundry staff worked 24/7. All I can say is it was HORRIBLE! Those nurses and doctors did everything they could but all total I think there was a total of 12 or 13 that died from that bug. All elderly people. The children survived, some better than others but they survived.

 

Sorry didn't mean to relapse there. But this bird flu scares the $&*^ out of me. Lord have mercy on us all if/when it ever makes it here. It is not going to be pretty, if it turns out to be anything like that stomach flu, I am no where near prepared.

 

Ok mt3b back to work. No sense in panicing over the unknow right now.

[HappyCamper45]

I'm thrilled there making these hard difficult decisions now. I'm not always in agreement with them but this will at least bring some clarity to the public as well as the medical professionals as to whom will treated ahead of time.

 

I think the stress on the medical professionals is going to be unbearable and to have guidelines such as these, may give sanity to such guilt there going to be feeling. At least the decisions have already been made to some degree.

 

Frankly after the first few days of an outbreak, people might as well stay home and try to treat your loved ones. Can you image bring them to the hospital so sick, just to be put in line like cattle?

 

 

 

[michelle]

This is a hard thing to think about but it is wise to have some order to it. I need to work on our preps for flu. I really hope we'll be prepared enough to treat this thing at home if it hits without having to deal with the medical facility. Our hospital here is so dysfunctional I honestly think I could do a better job of treating them with a good manual and some appropriate supplies. Just something to think about when we decide whether or not to make a risky trip to the facilities during a pandemic... if we know their criteria we know whether or not it will even do any good to go.

[Ambergris]

Some years ago, the flu hit here very hard. The local "big hospital" was lining people up on gurneys in the halls because there weren't enough rooms. The news was saying don't go to the hospital. My doctor still decided I was sick enough to be admitted to the hospital. My husband disagreed and treated me with hot fresh-picked limeade sweetened with honey and spiked with ginger. For a few weeks, I couldn't breathe lying down. If I had gone to the hospital, I would assuredly have died.

 

If I could obtain Tamiflu only by going to the doctor, we would go to the doctor. Otherwise, we will avoid contact with other people as much as possible.