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Thread: Who would MDs let die in a pandemic?

  1. #1

    Who would MDs let die in a pandemic?

    I was reading this article and was thinking how difficult it would be to actually say to someone, sorry we can't treat you. I understand the reasoning behind the plan, but it still would be a gut wrenching decision.



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

    TANNER, AP Medical Writer
    2 hours, 53 minutes ago

    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.

    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:

    _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
    Last edited by chicadeel; 05-05-2008 at 12:49 PM.

  2. #2
    My answer would have be easy - Pats* fans

  3. #3
    Welcome to Government run healthcare. Government will decide who gets treated and when!

  4. #4
    only Moga can answer this :rolleyes:

  5. #5
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    [QUOTE=Dirtstar;2524662]only Moga can answer this :rolleyes:[/QUOTE]

    He is putting on his rubber gloves and will be typing a reply shortly.

  6. #6
    Actually discussed something like this in one of my classes. In the Triage centers of emergency rooms they classify people into 3 categories.

    I- Will probably die even if treated immediately
    II- Will most likely survive if treated immediately, Will die if left untreated.
    III- Not life threatening, can wait.

    So basically the hierarchy of whose treated is II > I > III

    may be a harsh reality but hospitals have a fixed amount of resources.

    So to answer the question. Those who are unlikely to survive will be ignored. Its horrible to think thats true. but what would be better? First come first serve would be absolute chaos and far more casualties
    Last edited by SantanaMoss83; 05-05-2008 at 01:03 PM.

  7. #7
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    [QUOTE=chicadeel;2524650]The proposed guidelines are designed to be a blueprint for hospitals "so that everybody will be thinking in the same way" [B][SIZE="4"]when[/SIZE] pandemic flu or another widespread health care disaster [/B]hits, said Dr. Asha Devereaux.[/QUOTE]

    When? No "if"?

    Do they know something we don't? :D

  8. #8
    [QUOTE]So to answer the question. Those who are unlikely to survive will be ignored. Its horrible to think thats true. but what would be better? First come first serve would be absolute chaos and far more casualties [/QUOTE]


    Well, if thats true I can see the point.
    But it seems to me, the guide line would be that if you met the criteria for not being treated, even if treatment would lead to surviving, you would be denied.

  9. #9
    [QUOTE=PlumberKhan;2524678]When? No "if"?

    Do they know something we don't? :D[/QUOTE]


    Man, you are sharp!;)

    Quick question, just in case.
    If I hooked Grandma up to a small air compressor would it be fresh air she would be getting?

  10. #10
    [QUOTE=MnJetFan;2524660]Welcome to Government run healthcare. Government will decide who gets treated and when![/QUOTE]

    Better than having Private Insurance Companies making these decisions. Like it or not, when it comes to your healthcare, you dont (and shouldnt) have 100% autonomy
    Last edited by kennyo7; 05-05-2008 at 01:39 PM.

  11. #11
    Phrasing it as "who should we let die" is quite gruesome. A better way to state it is how do we prioritize patients in this situation.

    People at the bottom of the list should be:

    - those with terminal diseases (incurable cancer, Alzheimers Disease, emphysema, pulm fibrosis, end stage heart failure)
    - those over age 80
    - those with mental retardation/severe handicap

    then it gets tricky.

  12. #12
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    Pandemics present a very unique set of issues for healthcare providers.

    On the first front is dealing with the incredible amount of excessive patients they would be expected to treat due to the pandemic.

    The second front is dealing with the short-staffed situation the provider will have to deal with. The rule-of-thumb when doing pandemic planning is to expect only 50-60% of your staff to be available. This is because some of them too will be sick, others will be unable to get about due to quarrantine / curfew orders in place and yet others will refuse to leave their homes due to fear of contracting the bug that caused the pandemic.

    Sadly the guidelines in the first post are only the first "rung" of the reality. Thruth of the matter is that it will be much more rigid than that.

  13. #13
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    [QUOTE=chicadeel;2524685]Quick question, just in case.
    If I hooked Grandma up to a small air compressor would it be fresh air she would be getting?[/QUOTE]

    It would be fresh air...it may smell a bit oily, but it might bring her back memories of all the Vitalis Grandpa put in his hair during the 40's.

    Oh...and you would want to turn the regulator waaaay down. Or you might end up inflating Grandma like a Macy's Thanksgiving Parade balloon. :P

  14. #14
    :nurse::balloon:


    Grandma's pandemic medical kit is now complete.

  15. #15
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    [QUOTE=SantanaMoss83;2524669]Actually discussed something like this in one of my classes. In the Triage centers of emergency rooms they classify people into 3 categories.

    I- Will probably die even if treated immediately
    II- Will most likely survive if treated immediately, Will die if left untreated.
    III- Not life threatening, can wait.

    So basically the hierarchy of whose treated is II > I > III

    may be a harsh reality but hospitals have a fixed amount of resources.

    So to answer the question. Those who are unlikely to survive will be ignored. Its horrible to think thats true. but what would be better? First come first serve would be absolute chaos and far more casualties[/QUOTE]

    I'm sure you've seen the movie "Saving Private Ryan"...

    remember the opening sequence when the medic is moving down the line of wounded GI's as the battle rages on Omaha and he's telling his assistant, "he's critical.....he's gone....he's fine"....

    hand-in-hand with what you said above....

  16. #16
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    [QUOTE=kennyo7;2524711]Phrasing it as "who should we let die" is quite gruesome. A better way to state it is how do we prioritize patients in this situation.

    People at the bottom of the list should be:

    - those with terminal diseases (incurable cancer, Alzheimers Disease, emphysema, pulm fibrosis, end stage heart failure)
    - those over age 80
    [B]- those with mental retardation/severe handicap[/B]

    [B]then it gets tricky.[/B][/QUOTE]

    You're implying that it only get tough to decide after letting the handicapped die....

  17. #17
    [QUOTE=CTM;2526355]You're implying that it only get tough to decide after letting the handicapped die....[/QUOTE]

    No. I imply it gets toughER

  18. #18
    [QUOTE=kennyo7;2524711]Phrasing it as "who should we let die" is quite gruesome. A better way to state it is how do we prioritize patients in this situation.

    People at the bottom of the list should be:

    - those with terminal diseases (incurable cancer, Alzheimers Disease, emphysema, pulm fibrosis, end stage heart failure)
    - those over age 80
    - those with mental retardation/severe handicap

    then it gets tricky.[/QUOTE]



    I can understand those with terminal diseases not being treated. But not treating people with mental retardation, severe handicap and people over 80 who all might otherwise be helped if treated and would die if not treated, just does not seem right.

  19. #19
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    [QUOTE=chicadeel;2526398]I can understand those with terminal diseases not being treated. But not treating people with mental retardation, severe handicap and people over 80 who all might otherwise be helped if treated and would die if not treated, just does not seem right.[/QUOTE]

    Saving people over 80 at the possible expense of younger people is not a good idea.

  20. #20
    But if you start to treat people by that type of criteria don't you think that it would invite a huge set of problems. Like for instance, if a person 80 or older was an asset to the community and a 20 year old was a nonproductive parasite. Who ya gonna treat.

    If a disaster of a significant magnitude or a pandemic occurred people who depend on assistance from the community or are not self sufficient(compressor) will be screwed. Why do you think all those survival shows are on the discovery channel. ;)

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