This alarming bit of “lifeboat ethics” public policy has reached my email through several sources:
Who should doctors let die in a pandemic?
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.
( I suspect that the list would also include at least some people with labels of mental retardation, since the rationale for withholding treatment would be the same.)
The list of “lifeboat rejects” includes:
- 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.
Lindsey Tanner, the author of the Associated Press article, sought out some critical comment on the proposed policy:
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.”
Real ethical concerns indeed. These “lifeboat rejects” are already some of the people likely to draw the short straw in what we call a healthcare system. Has anyone bothered to ask how this triage list will affect attitudes toward individuals now deemed as “rejects” now? Hospitals will now have policies listing these individuals as unworthy of lifesaving efforts in an emergency. Will that affect the way medical providers see them right now?
It’s not as though individuals on this list are highly valued or respected in the system as it is.
I have many friends who would fit on this list. I have two pieces of advice for them:
- Be afraid. Be very afraid.
- Once you’ve gotten that out of your system, start organizing and raising a stink about it. –Stephen Drake