Who should MDs let die in a pandemic? Report

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

By LINDSEY TANNER, AP Medical Writer Mon May 5, 9:47 AM ET

CHICAGO - 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. 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 town 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. "

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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