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A30 FEATURE
Tuesday 31 March 2020
How would overwhelmed hospitals decide who to treat first?

By CANDICE CHOI, LORI cial status or other personal
HINNANT and NICOLE WIN- factors. Berlinger noted
FIELD Associated Press that underlying social ineq-
NEW YORK (AP) — A nurse uities can still persist -- for
with asthma, a grandfa- example, poorer people
ther with cancer and a tend to be sicker -- but that
homeless man with no those are deeper injustices
known family are wracked that can’t be remedied in
with coronavirus-induced the throes of a pandemic.
fevers. They are struggling Another grim calculation
to breathe, and a ventila- that experts say hospitals
tor could save their lives. could make is how long a
But who gets one when patient might need a hos-
there aren't enough to go pital bed or ventilator and
around? how many more lives the
Health care workers are machine might otherwise
dreading the prospect of save. That would help fore-
such dire scenarios as U.S. stall an even more wrench-
hospitals brace for a loom- ing decision many doctors
in the U.S. likely have never
faced -- whether to take a
patient off a machine to
File photo shows medical supplies and a stretcher displayed before a news conference at the free it up for others.
Jacob Javits Center in New York. Health care workers are dreading the prospect of deciding The norms don’t apply in
which patients would get a ventilator that could save their lives. (AP Photo/John Minchillo, Fle) the current crisis and taking
Associated Press precious resources away
ing surge in patients who many of which already are ited ventilators in major from one patient to save
need breathing machines being used by other pa- emergencies, but note that others in a pandemic “is not
and other resources that tients. making old age an auto- an act of killing and does
could soon be in critically In New York, the U.S. epi- matic disqualifier would be not require the patient’s
short supply. center of the outbreak, discriminatory. The plans consent,” said a paper
That has meant dusting off one city hospital has al- go on to add, however, addressing the COVID-19
playbooks they’ve never ready logged 13 corona- that given the “strong soci- emergency published last
before had to implement virus deaths in a single day etal preference for saving week in the New England
on how to fairly ration lim- and officials are setting up children,” age could be Journal of Medicine.
ited resources during an hundreds of hospital beds considered in a tie-break- The authors noted that
emergency. in a sprawling convention er when a child’s life is at patients and their families
“I pray for their good judg- center as cases climbed stake. should not be shielded from
ment and their capacity past 30,000 in the city. Recommendations pub- the realities and should be
as they make very difficult In preparation, health offi- lished this week by German warned in advance of the
choices,” said Erik Curren, cials across the country are medical associations in re- possibility their loved one
whose 77-year-old father reviewing guidelines from sponse to COVID-19 also could be taken off a ma-
died this month from re- sources including state say age alone shouldn’t be chine.
spiratory complications re- governments and medical a deciding factor. Among Hospitals should also pre-
lated to the virus after be- groups on how to ration the situations where they pare alternatives for those
coming infected at an as- limited resources in emer- said intensive care should who don’t make it to the
sisted living home in Florida. gencies. not be provided if avail- top of the list for limited re-
Harrowing scenarios al- The general principle span- ability is in short supply: if sources, such as stocking
ready are unfolding in ning those plans: Bring the the patient would need up on morphine, said Philip
country after country hard- most benefit to the great- permanent intensive care Rosoff of Duke University’s
hit by the COVID-19 pan- est number of people and to survive. Trent Center for bioethics.
demic, including Spain, prioritize those with the best The crushing emotional It’s not yet known how dire
where one nursing home chance of recovery. But burden of carrying out po- the crisis in the U.S. will get.
official said sick residents exactly how that’s deter- tentially life-and-death de- Last week, Dr. Deborah Birx,
are dying after being un- mined is fraught. cisions is why the guidelines the White House coordi-
able to get into overflow- Automatically excluding typically designate sepa- nator for the coronavirus
ing hospitals. certain groups from re- rate triage teams to make response, sought to calm
Like much of the rest of the ceiving ventilators, such as the call, rather than leaving fears, noting there’s no evi-
world, ventilators that help those with severe lung dis- it to the doctors and nurses dence yet that a hospital
people breathe are in par- ease, invokes ethical issues, providing bedside care. bed or ventilator won’t be
ticular demand across the said Dr. Douglas White at “This is a really terrifying available for Americans
U.S., given the respiratory the University of Pittsburgh. decision -- you don’t want when they need it. Even in
problems common among Many hospitals seeking any doctor or nurse to be New York, she said, beds
people severely ill with CO- guidance on COVID-19 alone with this decision,” are still available in inten-
VID-19. As many as 900,000 in recent weeks have ad- said Nancy Berlinger of the sive care units and a signifi-
coronavirus patients in the opted a policy he devised Hastings Center, a bioeth- cant number of ventilators
U.S. could need the ma- without such exclusions, he ics research institute. aren’t being used.
chines during the outbreak, said. Guidelines previously Having separate teams But what’s happening
according to the Society developed by New York make decisions also is in- overseas has health care
for Critical Care Medicine. state’s health department tended to ensure patients workers around the world
Yet the group estimates the exclude some seriously ill get a fair shot at care re- preparing for worst-case
country has only 200,000, people from receiving lim- gardless of their race, so- scenarios.q