Who should MDs let die in a pandemic? Report offers answers

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.

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 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.


'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:

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.

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.'

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Posted by AttarahJ
The recommendations would probably violate federal laws against age discrimination and disability discrimination, said Gostin, who was not on the task force.

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no ones life is more worthy than the next.

Interesting article. I'm not sure whay you posted it? Are you trying to get people upset?

I have a minor in Emergency and Disaster Management and what the article is talking about is how mass triaging is done in case of a disaster. It's unfortunate, but this is how things are done to try and save as many lives as possible in emergency situations with limited resources. This process does not value one human life more than another but the triaging is done to determine who has the best chance of living with the resources on hand.

For many people that don't know about Emergency and Disaster management this can be a very unpleasant article to read, again, i'm not sure why you posted this, especially on the NW board?

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Posted by FullersBride

Interesting article. I'm not sure whay you posted it? Are you trying to get people upset?

I have a minor in Emergency and Disaster Management and what the article is talking about is how mass triaging is done in case of a disaster. It's unfortunate, but this is how things are done to try and save as many lives as possible in emergency situations with limited resources. This process does not value one human life more than another but the triaging is done to determine who has the best chance of living with the resources on hand.

For many people that don't know about Emergency and Disaster management this can be a very unpleasant article to read, again, i'm not sure why you posted this, especially on the NW board?

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i agree- this could be a set up for drama.

i also realistically understand what youre saying about triaging, my comment is really just out of sadness that that would be how its handled.

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Posted by Aug07OFCbride

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Posted by FullersBride

Interesting article. I'm not sure whay you posted it? Are you trying to get people upset?

I have a minor in Emergency and Disaster Management and what the article is talking about is how mass triaging is done in case of a disaster. It's unfortunate, but this is how things are done to try and save as many lives as possible in emergency situations with limited resources. This process does not value one human life more than another but the triaging is done to determine who has the best chance of living with the resources on hand.

For many people that don't know about Emergency and Disaster management this can be a very unpleasant article to read, again, i'm not sure why you posted this, especially on the NW board?

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i agree- this could be a set up for drama.

i also realistically understand what youre saying about triaging, my comment is really just out of sadness that that would be how its handled.

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Don't worry, the comment wasn't directed to anyone, it was just an explanation for the process. I have been in the situation where i've had to triage people and it's not pleasant. You work like a machine following a set of guidlines without emotion. It is sad, and my wish is that no one would ever have to deal wiht it.

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Posted by AttarahJ

How will start drama? I posted something that I thought might be informative. I didnt hear about this on the news or in any other news forum. There is nothing wrong with people having discussions, there are some people who have parents, grand parents that may fall into this catagory, I know DH and I both do and if there is a time where legislative representative make this into something that can be voted upon I'd like the chance to speak my piece.

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point taken.

i think i may fall into one of the categories as well bc of chronic illness, not sure. so i understand that its impt to know.

im really sorry to hear about your mom.

The point is, for something like this to happen there would have to be a very sever pandemic. It is an interesting article but most readers, most likely your self included, have no idea how much more information and knowledge you are missing to undestand what this is saying.

I don't think most people could comprehend how bad things would have to be for them to start basically triaging people like this.

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Posted by FullersBride

The point is, for something like this to happen there would have to be a very sever pandemic. It is an interesting article but most readers, most likely your self included, have no idea how much more information and knowledge you are missing to undestand what this is saying.

I don't think most people could comprehend how bad things would have to be for them to start basically triaging people like this.

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I understand what you're saying. I'd like more information about something like this though. You see stuff like this in movies and you shrug it off as is that's not a plausible situation. I was a bit surprised by the article, Can a situation like this really happen? If so, can the CDC and Government implement such a law?

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Posted by AttarahJ

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Posted by FullersBride

The point is, for something like this to happen there would have to be a very sever pandemic. It is an interesting article but most readers, most likely your self included, have no idea how much more information and knowledge you are missing to undestand what this is saying.

I don't think most people could comprehend how bad things would have to be for them to start basically triaging people like this.

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I understand what you're saying. I'd like more information about something like this though. You see stuff like this in movies and you shrug it off as is that's not a plausible situation.

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Totally understandable. It is a scary thing to read and panic beacuse of loved ones, but a situation would have to be truly catastrophic for this to take place, and unfortunately, those who are older or more seriously injured woudl most likely die anyways. I wouldn't worry to much about it. It is good to be aware of how things are done but some times knowledge is dangerous if you don't have all of the information.




edited to add:

As for situations like this happening, it happens everyday on a smaller scale. When you go to the ER you are 'triaged' by a nurse who decides how critical you are and when you fal in line in order of treatment.

During car accidents the EMTs adn Paramedics traige patients on order of necessity, those who have passed away at the scene of an accident are left, there, there is slim to no chance of revival so they focus their efforst on those they can help.

THe article is talking about implementing this on a grander scale. When Sept 11 happened, they had teams of people set up just to triage patients in this manner. THis happens on the battlefields as well. It is a system that has been in place for years. The idea of the article is to get all hospitals on the exact same protocol in case of a pandemic or MCI (multiple casualty event)

Having had the experience of making many trips to the ER with my Mom I knew that hospitals had such a system. Some even have signs that state they see patients depending on the severity of thier illness/situation. I just didnt know the government could or does have a say in issue such as this in hospitals. Thank you again for shedding light on this subject. This is why I like having these discussion b/c someone usually has some expertise in an area and can be very informative. Thank you.

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Posted by FullersBride

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Posted by AttarahJ

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Posted by FullersBride

The point is, for something like this to happen there would have to be a very sever pandemic. It is an interesting article but most readers, most likely your self included, have no idea how much more information and knowledge you are missing to undestand what this is saying.

I don't think most people could comprehend how bad things would have to be for them to start basically triaging people like this.

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I understand what you're saying. I'd like more information about something like this though. You see stuff like this in movies and you shrug it off as is that's not a plausible situation.

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Totally understandable. It is a scary thing to read and panic beacuse of loved ones, but a situation would have to be truly catastrophic for this to take place, and unfortunately, those who are older or more seriously injured woudl most likely die anyways. I wouldn't worry to much about it. It is good to be aware of how things are done but some times knowledge is dangerous if you don't have all of the information.




edited to add:

As for situations like this happening, it happens everyday on a smaller scale. When you go to the ER you are 'triaged' by a nurse who decides how critical you are and when you fal in line in order of treatment.

During car accidents the EMTs adn Paramedics traige patients on order of necessity, those who have passed away at the scene of an accident are left, there, there is slim to no chance of revival so they focus their efforst on those they can help.

THe article is talking about implementing this on a grander scale. When Sept 11 happened, they had teams of people set up just to triage patients in this manner. THis happens on the battlefields as well. It is a system that has been in place for years. The idea of the article is to get all hospitals on the exact same protocol in case of a pandemic or MCI (multiple casualty event)

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I agree. Its HORRIBLE to think anyone might be untreated because of age, sex, or illness BUT in an emergency situation you have to think triage. Its how its done in emergency rooms as well; the ones most in need have to come first. In emergencies its who is likelier to survive.

If you're trying to rescue people in a burning building, who do you go after first? The infant and mother all the way in the back trapped beneath burning rubble that would take more manpower than you have to lift up, or the guy in front who's kind of a loser BUT he is right there and his chances of surviving are much better?

Its undoubtedly a choice NO ONE woudl want to make but as Maria poinrted out, it would have to be a really severe emergency like 9/11 for somethign this drastict to be employed.

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Posted by Aug07OFCbride

i understand all the practical reasons people give for this type of system. not for nothing though...whether its a likely circumstance or not (which really we have no idea), you have to understand thats its probably going to be easier to remain a little more emotionally distanced or speak about it in black and white if you think you won't be one of the people who would likely be denied care, ya know. its just sad. im not sure if id be affected but it still makes me really sad so maybe i seem a bit more emotionally charged about it than certain ppl might. either way, im glad im aware of it.

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I understand what you are saying. Although I don't have a serious medical condition, I can't say I'm safe. If I was in a car accident and lost my leg and was pinned in a car and was bleeding out and you were in another car and had a broken leg but could get out easily, illness or not, they would take you out first and tend to me last, if at all. No one is exemped from this, it is all based on different scenarios.

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Posted by FullersBride

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Posted by Aug07OFCbride

i understand all the practical reasons people give for this type of system. not for nothing though...whether its a likely circumstance or not (which really we have no idea), you have to understand thats its probably going to be easier to remain a little more emotionally distanced or speak about it in black and white if you think you won't be one of the people who would likely be denied care, ya know. its just sad. im not sure if id be affected but it still makes me really sad so maybe i seem a bit more emotionally charged about it than certain ppl might. either way, im glad im aware of it.

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I understand what you are saying. Although I don't have a serious medical condition, I can't say I'm safe. If I was in a car accident and lost my leg and was pinned in a car and was bleeding out and you were in another car and had a broken leg but could get out easily, illness or not, they would take you out first and tend to me last, if at all. No one is exemped from this, it is all based on different scenarios.

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yep

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Posted by AttarahJ

How will start drama? I posted something that I thought might be informative. I didnt hear about this on the news or in any other news forum. There is nothing wrong with people having discussions, there are some people who have parents, grand parents that may fall into this catagory, I know DH and I both do and if there is a time where legislative representative make this into something that can be voted upon I'd like the chance to speak my piece.

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You are totally right. That 'drama' comment was very small-minded.

Yup, read again, I said that the comment was small-minded, not that the person who wrote it was small-minded.

Re the article itself, I think it's totally necessary to have some plan of action, otherwise there would be nothing but chaos. Unfortunately, some people may suffer, but it is necessary for the greater good. IMO.