Toronto Mike

Deciding Who Can Die


Doctors are debating who would die in a pandemic.  A list of new recommendations have appeared in the May edition of Chest, the medical journal of the American College of Chest Physicians.

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.

This has raised all sorts of ethical questions.  Can doctors ethically let someone die?  Is it fair to value one life more than another?  Does this strategy discriminate against the poor?

I'm glad these discussions are taking place and that we're preparing a blueprint for hospitals when pandemic flu or another widespread health-care disaster hits.  That's when it hits, not if it hits, because it's just a matter of time before doctors are forced to refer to such rules.

The fact is, if there are two people and only one can be treated, both lives are not equal.  It's not easy to admit, but it's a sensible truth.  Why work on reviving a 70 year old man with heart problems if there's a healthy 30 year old woman to treat?  When it's time to make these tough calls, I want everybody on the same page.

And yes, I write this as a healthy 30 something year old, but sincerely believe I'd feel the same if I were a sickly 80 year old.  Just ask me in 50 years.

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