The premise is simple. With a static number of ventilators, the demand for them could exceed the supply. States across the country have different guidelines for rationing such devices, anything from:[ul]
[li]Allowing medical professionals to decide, i.e. nothing on the books[/li][li]Denying treatment to people with disabilities or dementia[/li][li]First come / first serve[/li][/ul]Citing the ADA, there are disability rights advocates who are calling for federalizing such guidelines, perhaps a semi-analogous throwback to the Mickey Mantle liver transplant debacle. There are others who might become incensed if their teenage child was denied a ventilator upon learning governmental regulations were written to favor a 50 year old patient with cystic fibrosis.
Personally I think a general set of specific qualifications should be published publicly. There should be no question as to who qualifies more and why.
There’s a lot of extreme bias in medicine and leaving it up to medical professionals in a private fashion just means either A) the rich man wins or B) being part of a traditionally biased-against population goes from a sentence of lifelong harrassment to death. Lets not do that.
Certainly these requirements should be made by medical professionals and not bureaucrats, but they can’t have clauses like “arabs will thank allah for suffering” and “native americans dont want medicine that isn’t blessed by their shaman.” And these aren’t asspulls, this is from a widely used medical textbook.
As soon as you leave it up to individuals with no accounting for how they made those decisions, you get crap like this all over the place.
It’s somewhat analogous to placement on the transplant list. The average life expectancy for heart transplant recipients is just over nine years, with 43% dying in the first ten years following transplant and 13% dying in the first year. My brother-in-law got one more than twenty years ago and is doing fine. A factor in this may be because his transplant physician gamed the system to get his patients who were otherwise not qualified moved up on the list. Hearts are usually reserved for the sickest patients.
The physician was thrown out of the transplant program after his actions became known, but from a strictly utilitarian point of view, is it better to have the heart go to a deathly ill person who might live only a year, or five, or should that heart go to a person in better shape who could get a couple of decades out of it?
In the transplant program scarce resources are reserved for the sickest patients, while it seems like the talk is that ventilators will be used for people most likely to recover. If there aren’t enough to go around somebody’s going to decide, and there should be clear and consistent rules so people don’t shop for a venue with policies that help them.
What disturbed me most were ideas floated that if, say, a respirator dependent person wound up in the hospital that doctors could confiscate the ventilator they came in with and give it to someone else. That should be verboten. Taking the property of someone who absolutely needs that property to continue to live.
The assignment of available to use ventilators in a crisis might justifiably be based on triage criteria in my view.
This isn’t quite so. You are overlooking the quality of the match. That is a high-level criterion that cuts past a simple rank-ordered list of frailty. And the idea that we should do these operations well before they are pressingly necessary also overlooks that these operations are huge, and have a non-trivial level of lethality. Transplant physicians talk about a patient’s ‘window’ - when they are sick enough that the surgical risks are worth it, but not so sick that they will not tolerate the operation. The idea of doing transplants early misses the fact that such an operation might well unnecessarily deprive the patient of some functional years by killing them through surgical risk.
As to the ventilator problem, for my part I would like to hear from people experienced in how the problem actually arises. It seems to me that the prime criterion is immediate medical need to prevent death, and when a ventilator becomes available, it will rarely be the case that two people with exactly the same level of need will be vying for it. And if it is common that such a situation is arising, that implies that Peak Overwhelm has arrived, where calm decision making of the order assumed by the advocates of some rule or other may not apply, so that with the best will in the world, a certain amount of ad hoccery is unavoidable.
Yeah, that’s what happens when you don’t have enough ventilators for the people who need ventilators to live. People will die. These teams of doctors are trying to minimize the number of people who die by deploying ventilators in a way to maximize lives saved.
So, they’re life panels, or anti-death panels, because their purpose is not to decide who dies, but to prevent as many deaths as possible during the crisis.