Docs list who would be allowed to die in a catastrophe
CHICAGO, Illinois (AP) -- 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 whom 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, California, 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:
鈥?People older than 85.
鈥?Those with severe trauma, which could include critical injuries from car crashes and shootings.
鈥?Severely burned patients older than 60.
鈥?Those with severe mental impairment, which could include advanced Alzheimer's disease.
鈥?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." Sounds good to me! It's called triage,,,help those that are most likely to survive in an immidiate emergency..also who is most capable in helping others when they do survive.
Choices have to be made...and sometimes those choices are not popular. Others have explained the whole triage thing. If there are limited resources are available they need to be used on those most likely to survive.
Sure this article could be offensive or controversial to some. But in a true catastrophe it would not be all so cut and dried. The article merely is to have health care professionals consider the possibilities and maybe be more menatlly prepared to make the tough calls. Rather than never have really done so and lock up when the tough choices could mean many more people live. It's call 'triage'. A French word and basically it means that those who can't be saved without using up a disproportionate amount of time and resources will be give what comfort care can be provided and aloud to die. In a disaster, a real disaster where outside help cannot be reasonably expected, it is the only reasonable thing that can be done. The 'key' word here is 'reasonable'.... You will see this come into effect with socialized medicine too. The tax payers cannot afford the burden of medical care and so you would see this type list put into action to decrease the budget. Triage is ALWAYS done everywhere whether people have made the list public or not. Nothing new there at all.
Harsh fact is in a crunch, which can be war, emergencies, etc. that this is ALWAYS done. Worse fact is that with socialized med/UHC/etc it IS done but hidden from the public.
FACTS:
The NHS, the oldest system, is in Britain:
"Staff are being laid off, and deficits are at an all time high (拢1.07bn for 2005-2006)鈥?(Hazel Blears, Labour Party Chair and Minister Without Portfolio, labourachievements.blogspot.com/2006/08/...
In the National Review Online article, Coburn & Herzlinger state 鈥渕ore than 20,000 Brits would not have died from cancer in the U.S.鈥?Just recently Alex Smallwood of the BMA (British Medical Association) was quoted in the Scotsman as saying: 鈥溾€橰ationing is reduction in choice. Rationing has become a necessary evil. We need to formalise rationing to prevent an unregulated, widening, postcode-lottery of care. Government no longer has a choice.鈥欌€?(Moss, 鈥淣HS rationing is 鈥榥ecessary evil,鈥?says doctors,鈥?26 June 2007).
"Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives."
http://www.telegraph.co.uk/news/main.jht...
Jewish World Review Feb. 12, 2008 / 6 Adar I 5768
http://www.jewishworldreview.com/jonatha...
In Canada, the Schiavo case with an outrageous twist
By Jonathan Rosenblum
An elderly Orthodox Jew is on life support. His children have adamantly opposed his removal from the ventilator and feeding tube, on the grounds that Jewish law expressly forbids any action designed to shorten life. If their father could express his wishes, they say, he would certainly oppose the doctors acting to deliberately terminate his life. The director of the ICU told the children that neither their father's wishes nor their own are relevant, and he would do whatever he decided was appropriate
In States,
"But the real-life story of 18-year-old Brandy Stroeder may come to embody a harsher truth: namely, that even as we perfect more and more advanced medical procedures, not everyone is going to have access to them. And, as Americans struggle to come up with an equitable health care system, that even the best-intentioned system can seem heartless when forced to balance the good of thousands against an individual's suffering.
The story began last fall when doctors told Brandy, who lives with her single mother in a weather-beaten farmhouse about an hour south of Portland, Ore., that she was likely to die within a year unless she got a simultaneous lung-liver transplant, an operation that has been performed fewer than a dozen times in the United States.
Under Oregon's unique Medicaid system, which openly rations healthcare in order to provide basic care to as broad a population as possible, Brandy was eligible for a liver transplant or a lung transplant, but not both. In January, and again after a review in May, the state-run health plan said no. There wasn't enough data to show the $250,000 procedure was worthwhile, the health plan's administrators said, and the plan didn't cover experiments.
But Brandy wouldn't take no for an answer. A tough, determined young woman who had managed to work part-time at a photo studio, baby-sit her boss's children, coach the high school football team and maintain a 3.2 grade point average between numerous and prolonged bouts in the hospital, Brandy wasn't about to give up her life without a fight. She sued the state of Oregon, charging that it was making a flawed moral choice in refusing to save her life. Since then her caustic, articulate criticisms of the Oregon system have given a vivid sense of the obstacles any universal healthcare plan for the nation would face.
"They'll pay for an alcoholic to get a liver transplant because they've been drinking all their life," she says, sitting with her mother at a rickety picnic table under a cherry tree by her front door. "They'll pay for a heroin addict to get cured, to help someone kick the cigarette habit. Those are things people do to themselves. If you put it to a vote the people would say pay for some girl's operation instead of some alcoholic's liver transplant or some crack head's needles. I just think it isn't very fair.'"
http://archive.salon.com/health/feature/...
Texas has also been the boldest in supporting the growing-in-popularity "futile care theory":
"Texas, however, has become ground zero for futile-care theory thanks to a draconian state law passed in 1999 鈥?of dubious constitutionality, some believe 鈥?that explicitly permits a hospital ethics committee to refuse wanted life-sustaining care. Under the Texas Health and Safety Code, if the physician disagrees with a patient's decision to receive treatment, he or she can take it to the hospital ethics committee. A committee hearing is then scheduled, all interested parties explain their positions, and the members deliberate in private.
If the committee decides to refuse treatment, the patient and family receive a written notice. At that point, the patient/family has a mere ten days to find another hospital willing to provide the care, after which, according to the statute, "the physician and health care facility are not obligated to provide life-sustaining treatment."
Since the patients threatened with death by ethics committee are often the most expensive to care for, it will often be difficult for families to find other institutions willing to accept a transfer. But the futility deck may be especially stacked against Houston patients. Many city hospitals participate in the "Houston City-Wide Guidelines on Medical Futility," raising the suspicion that participating hospitals will not contradict each other's futility decrees.
If so, this would mean that patients seeking refuge from forced treatment termination will have to be transported to distant cities, as has already occurred in a few futile-care cases, perhaps even out of state. Illustrating the level of hardball some hospitals play against patients and families, the Clarke family's lawyer Jerri Ward told me that St. Luke's agreed to pay the $14,806 transportation costs to transfer Clarke to a hospital in Illinois 鈥?more than 1,000 miles away 鈥?if the decision to transfer is made on Thursday (4/27). If the family doesn't decide until Friday, the hospital will pay only one-half of the cost of transportation. Thereafter, it would pay nothing."
http://www.nationalreview.com/smithw/smi...
Etc. |
