Doctors Playing God? The ‘Live and Let Die’ List.
by 
Liz on May 7th, 2008
‘To treat or not to treat’ in the event of a widespread pandemic or disaster is a question that has always haunted health professionals.
Now a group of physicians think that they might have the answer on how to deal this this issue. A task force drawn from universities, medical groups, the military and government agencies (including the Dept of Homeland Security, the Center for Disease Control and Prevention, and the Dept of Health and Human Services) in the United States have proposed some guidelines that can act as blueprint for hospitals in times of pandemics or extreme disasters.
The reasoning behind creating such guidelines is so that scarce resources - ventilators, medicine, and health professionals - are used in the most objective and effective way.
The final report, published in the May edition of Chest, the medical journal of the American College of Chest Physicians, states…
“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.”
What this means is that some people will automatically be triaged into the ‘no treatment’ category. This includes people at high risk of death and a slim chance of long-term survival. For example…
- 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.
Ths report, as you can imagine, opens up a minefield of ethical and moral issues and is already creating a lot of debate.
As a health professional, I understand the need for having some sort of guidelines but it still feels a little like ‘Playing God’. And when it’s all written down in black and white, it just looks awful cold and uncaring.
So I’m curious.
What do you all think?
Is it ethical? Is it moral?
Let’s talk….
(source: CNN)
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POSTED IN: Exposed!, Extreme, Health, Healthcare, Medicine, Misc., Treatment
3 opinions for Doctors Playing God? The ‘Live and Let Die’ List.
May 7, 2008 at 7:19 am
The ideal would be that we have enough medicine and personnel to treat everyone. It’s horrible that front-line medical staff have to make a decision about whom to treat, but that’s inevitable. You either make a conscious decision and maximize your impact or you do something like first-come, first-served in which case you use resources on “hopeless” cases.
I know it makes a difficult situation more real and stark when put in black-and-white. Maybe it helps to think about the people that triage allows you to save that would otherwise have died.
Whenever I think about these cases, I try to remember circumstances where they would be used. In the 1918 Influenza Epidemic, there were so many dead that people had to place marks on their doors to notify “disposal units” to collect bodies en masse. Ships would set sail from the States full of healthy young men to fight the War and arrive in England with 50-90% dead before seeing a single battle.
These extreme events are so removed from our normal experiences that we may not appreciate just how devastating they can be. If we want to provide any health care at all, we need to be smart about it, even if that gives the appearance of callousness.
It would be just fine with me if we never get to experience these things first hand, but if we do, count me as a reluctant supporter of triage.
May 7, 2008 at 12:19 pm
I also see how this may be needed…but I hate it. I don’t want to be on the decision-making team, but I know there are caring, competent professionals who can do this if necessary.
If nothing else, maybe it will prompt people to listen to CDC warnings: prepare your home and family and workplace for a pandemic, get the flu vaccine every year (even if it’s not the right strain, you may get some cross-protection), and if there is an outbreak, listen to officials and do as advised!!!
May 11, 2008 at 12:22 am
Hi Adrian and Kula, thanks for your comments….I agree that it is a necessary evil - I just hope I’m never in the situation that I have to help make those decisions…
Kula, you are so right about people also being prepared — individual responsibility is a big part of the equation.
sorry to take so long to reply but have been away from the computer this week.
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