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Author Topic: Government Report Answers Who Lives, Who Dies in Flu Pandemic  (Read 1184 times)

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Offline Eeyore

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Government Report Answers Who Lives, Who Dies in Flu Pandemic   
Monday, May  05, 2008
FC1
Should doctors be allowed to play God?
In the case of a flu pandemic yes, say government officials in a new report.
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.
Who will die in the event of a pandemic? The very old, seriously hurt, severely burned and those with severe dementia, according to an influential group of physicians.
The group has drafted a grimly specific list of recommendations for which patients wouldn't be treated.
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."
The
    "Hey, hey, hey, hey now.  Don't be mean.  We don't have to be mean. because, remember, no matter where you go, there you are."      - The Adventures of Buckaroo Banzai across The Eighth Dimension

Offline julymorning

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Re: Government Report Answers Who Lives, Who Dies in Flu Pandemic
« Reply #1 on: May 06, 2008, 01:04:12 AM »
You know what stuck out the most in this article, when I read it, was the "severely burned Patients over 60".
None of the scenarios they give are really acceptable, but this one is tears me up the worst. 
Just what exactly WOULD they do for a "severly burned Patient over 60"?  Would they at least administer morphine to block the hideous pain?  Euthenize them?  Let them lie there and suffer?
Obviously, if they are talking about catastrophic events, the latter would their choice.  Guess we all have something to look forward to after we hit 60.
Hey, it's just me, Suzi


retired1_us

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Re: Government Report Answers Who Lives, Who Dies in Flu Pandemic
« Reply #2 on: May 06, 2008, 01:13:04 PM »
Interesting, yet disturbing at the same time.  The underlying message for those in the selected for disposal categories will be left to fend for themselves if they aren't in a care facility and if they are they will be terminated.

All that kept running in the back of my mind was Soilent Green.

Offline julymorning

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Re: Government Report Answers Who Lives, Who Dies in Flu Pandemic
« Reply #3 on: May 06, 2008, 01:52:20 PM »
What was running in the back of my mind was "The Day After".
Cases where catastrophic events either partially wipe out ER caregivers and facilities and/or where  hundreds of people hit triage at the same time.  Wouldn't necessarily have to be a nuclear bomb incident.  Major earthquake in a large city could cause fires for instance.
Hey, it's just me, Suzi


retired1_us

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Re: Government Report Answers Who Lives, Who Dies in Flu Pandemic
« Reply #4 on: May 06, 2008, 02:21:04 PM »
What was running in the back of my mind was "The Day After".
Cases where catastrophic events either partially wipe out ER caregivers and facilities and/or where  hundreds of people hit triage at the same time.  Wouldn't necessarily have to be a nuclear bomb incident.  Major earthquake in a large city could cause fires for instance.

Yeah, I can see that too - available health care providers and emergency operations personnel would be an issue.

We do have other assets in place as well though, so that is why it disturbs me.  These guys for instance have multiple roles - not just WMD:

http://www.ngb.army.mil/features/HomelandDefense/cst/index.html

Offline julymorning

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Re: Government Report Answers Who Lives, Who Dies in Flu Pandemic
« Reply #5 on: May 06, 2008, 02:36:43 PM »
I would think that anyone with any kind of medical training would step in and try to help rather than stand by and ignore the suffering of someone because they fall into some kind of list.  It's disturbing to imagine that kind of cold heartedness, as well as imagining the government requiring a soldier to shoot to kill anyone who tries to help an "on-lister"  Not that anyone said that would happen, but my imagination is running wild here.

It has to be considered that getting people trained in emergency medical to a catastrophic area would be a challenge in of itself.  But that is just manpower.   Critical drugs and equipment availablity for a mass number of injuries is another matter too.
Hey, it's just me, Suzi


retired1_us

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Re: Government Report Answers Who Lives, Who Dies in Flu Pandemic
« Reply #6 on: May 06, 2008, 02:49:13 PM »
Agreed on all points.  And, I wasn't implying anything other than humanitarian assistance with the NGB CST site.  Point being, 9/11, Katrina, etc have shown we are ill prepared to take care of such things.

Hopefully we can grow the response programs to a point those measures won't be necessary.  One must wonder at that point if this panel's findings will be used for that purpose (growth), or just as a matter of fact that's just the way it is folks finding.

Offline What_The?

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Re: Government Report Answers Who Lives, Who Dies in Flu Pandemic
« Reply #7 on: May 06, 2008, 03:03:09 PM »
Dollar to a donut that the cost of this "study" to determine who lives and dies would have been more than enough to ensure every man, woman and child in the US would be protected in the event of such a disaster.
"There are plenty of good reasons for fighting, but no good reason ever to hate without reservation, to imagine that God almighty Himself hates with you, too. Where's evil? It's that large part of every man that wants to hate without limit, that wants to hate with God on its side." - Kurt Vonnegut

retired1_us

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Re: Government Report Answers Who Lives, Who Dies in Flu Pandemic
« Reply #8 on: May 06, 2008, 03:08:57 PM »
Good call  + karma