Allocating Ventilators in Times of Crisis: A Brave New World

Opponents warn that assisted suicide laws are inherently discriminatory because they carve out a group in society whose lives are deemed “not worth living.” Consequently, instead of receiving society’s protection and suicide prevention services, these individuals are provided suicide assistance.  This is especially dangerous given our broken profit-driven healthcare system where individuals with disabilities, the economically disadvantaged, and the elderly already struggle with accessing quality care due to health care disparities.

Many disability rights advocates, patients rights advocates, medical professionals, and ethicists are warning that using qualitative judgements to determine who will receive care or not is a very dangerous road to go down.

“The unprecedented COVID-19 crisis has challenged us, as a society, to evaluate our core values and philosophy. Ventilators, a precious and limited commodity, are now in short supply. Humanity is at a precipice, and we physicians are facing an ethical dilemma, how best to allocate ventilators, and, tangentially, a decision of who is “more worthy” of receiving these life-saving machines. In essence, we are being asked to play God, a role that, if history has taught us anything, is fraught with horrible consequences and regrets.

Realizing that clinicians are ethically torn with such a dilemma, distinguished bioethicists and select think tanks have codified a set of guidelines to help clinicians make such a decision. There are scoring systems created to determine who gets to be at the “top of the class” and who is relegated to the “bottom of the class”; hence, the top of the class are those worthy of life-saving measures, whereas those at the bottom of the class…well, sorry, our hands were tied…

Although these guidelines were created to address trying times, in my humble opinion, they are fraught with dangers and go against the Hippocratic Oath: “Do no harm and, above all, I must not play at God.” Our responsibility, as clinicians, is to protect the vulnerable and the voiceless, not to create a “Brave New World.” These guidelines also appear to be self-serving; since we health-care workers have the key to life, we therefore get to use ventilators first. Is that really a noble endeavor? What will society think of us and our noble profession?

…I do not have all the answers to this perplexing problem, but I do know the current suggestions are not them. We need to reassess current guidelines and stay true to the principle of patient autonomy and nonmaleficence. The bond between the patient and the physician is a sacred one. Patients come to us, fully trusting we will treat them as if they were our own family members…

No other time in our life is more critical than now, and how we care for vulnerable patients will be judged by generations to come. Will we be haunted by following guidelines that are modeled after The Hunger Games, or will we stand proud knowing we provided the best care for all to the best of our ability? In these unprecedented times, lives will be lost, but we, as a society, should take solace in being able to preserve our humanity. When all of this is over, and it will be, do we want our children to ask us, “I wish Grandpa was here to help me finish the bookcase. Why did the doctors let him die?”

Read more at ASCO Post…

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