who should MDs allow to die in pandemic?

who should MDs allow to die in pandemic?

www.msnbc.msn.com

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.

(visit the link for the full news article)

this is a pretty hardcore ethical issue, and while on the surface it may seem (harshly) logical and even neccessary, i feel as if this will open a pretty scary door into what will define a person's right to life-saving treatment: money and connections, rather than age and health. as a nursing student, for emergency situations i've been taught to offer care starting with those in most urgent need; being handed a list of criteria like this and told to weed out a packed ER waiting area accordingly feels like a direct contradiction of what a caregiver is supposed to do.

www.msnbc.msn.com
(visit the link for the full news article)

its called `Triage` and has been practised for years - you know when you go to A&E (emergency room) and the nurse asks you lots of questions? she/he is assesing how hurt you are and how fast you need to be seen.

anyway

www.abovetopsecret.com...

you got scooped

obviously this is very different than the usual assessment you receive in an ER. they are suggesting treatment on the basis of survivability, not need: the exact opposite of triage...hence the story.

erm no it IS triage - the entire concept was started within the military simple question - will this person survive without care? yes - heres the first aid kit ; no go to next part

will this person survive with care? yes - onto the table , no - heres the morpheine now go to that corner and die quietly please.

and thats it - the use of resources based upon ability to survive - in a mass casuality situation you are overwhelmed so it has to be fast and gruesome to decide what resources to use.

i know its a movie but watch the triage in the film `pearl harbour` when the wounded navy starts arriving - thats exactly how it would be in the situation described.

mark then with a C if critical , give them pain killers and move on.

The art of "triage' does NOT have to taught to these medical specialists. Comparing this to mundane triage is inappropriate.

In the case of a pandemic where hundreds are dying in their homes and outside hospitals, people are going to be denied the opportunity to receive medical care. Ambulance drivers are not going to cart bus-loads of ineligible patients to a hospital to have them thrown out to the parking lot, or worse. They will need police assistance just to keep people from trying to 'force' them to take their parents, or loved ones to the hospital. This is the reality of 'Pandemic', not the soft-core version your seeing on TV.

These elderly, and suffering are to be left where they are. THAT'S the kind of 'triage' we are referring to.

People watch way too much TV.

If anyone or their loved ones fall into any of those categories, you had better start researching medical procedures you might need to perform on yourselves or loved ones and get the supplies needed. Not a bad idea even if there is no pandemic.

This statement is slightly worrisome, is there someone here who might clear up this issue for me a bit?

See source for more information (MSNBC)

They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.

(Emphasis Mine)

From my (limited) understanding of dementia, how would sound, valid, tests be performed in a situation in which, as has been stated by others above, there may be many people trying to get into a hospital and being turned away? Dementia is often difficult to diagnose (as I understand it) and is sometimes riddled with false positives. Can someone explain to to me how this particular item (dementia) could not devolve into a situation in which this diagnosis was used to unfairly turn people away when they might actually be in the class of people who would normally be "worth saving"?

Furthermore, is there a definitive definition of "severe" dementia, or is the qualifier "severe" somewhat arbitrary and left up to the doctors to decide? Whenever I see qualifiers like that in front of already vague terms (such as dementia) it bothers me all the more. Hopefully I am just ignorant of the true meanings of these words and they are actually well defined in medical parlance.

Confusing and scary, this is.

(Edit for clarification of "severe" qualifier...)

[edit on 5-5May-08 by WoodyAcres]

sound tests? if you even appear to have it - you get a red C and go to the corner.

this is 100,000 people going to ceder sinai all at once - thats the first hour alone.

Perhaps I viewed the issue differently than most.

When I read it, I thought it refered to who gets meds and such....the "have's" VS "the have not's."

Who should get the med, they one who can pay or the younger person?
All or just Legal citizens?

The reason this needs to be examined is that if it happens, we will see the answer to these questions and we may or may not be prepared for the answers.

Im not sure why some of you are "worried" or freaking out about this...

a) I would much rather have a convo about this now, rather than when the time comes.

b) if the situation is that bad, yes, I would rather my 28 y/o bum have higher priority over someones 80 something grandma with health problems.

c) survival of the fittest / thinning the herd probably isn't a bad thing.

besides, in emergency situations, don't they kinda follow those rules now?

Originally posted by pynner
Im not sure why some of you are "worried" or freaking out about this...

[...snip...]

c) survival of the fittest / thinning the herd probably isn't a bad thing.

"Freaking"? No. Worried - about the "thinning of the herd"? No. In fact, I agree with the points made.

My point is that words are powerful tools (or weapons) when used just so. "Severe dementia" seems to me to possibly be just such a set of words that would potentially be misused. I have seen definitions of dementia that leave a lot of latitude for interpretation. For example:

Definition of Dementia from MedlinePlus (click to see entire entry)

People with dementia may not be able to think well enough to do normal activities, such as getting dressed or eating. They may lose their ability to solve problems or control their emotions. Their personalities may change. They may become agitated or see things that are not there.

Or this list (shortened to include only the main signs, not the details of each sign):

List of Signs from Familydoctor.org (click to see more)

1. Recent memory loss
   
2. Difficulty performing familiar tasks.
   
3. Problems with language.
   
4. Time and place disorientation.
   
5. Poor judgment.
   
6. Problems with abstract thinking.
   
7. Misplacing things.
   
8. Changes in mood.
   
9. Personality changes.
   
10. Loss of initiative.
    

Many of these signs are more subjective than objective. Thus, it seems to me that depending upon who the "powers that be" are that are running the show in such a situation might take a more or less conservative approach to these signs than they might in more "normal" (read: non-pandemic) times.

Surely one can imagine a situation in which a hospital administration decides that those that, for example, believe that the pandemic is the result of a conspiracy (just for the sake of argument) are potentially in a state of dementia. What signs might be used to justify such a diagnosis? From the above list these might be "Poor judgement", "Problems with abstract thinking", "Changes in mood" (if the person is not normally open about such thoughts, for example) and "Personality changes" (which, had I written the details for each item goes as follows for this item: "People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful.")

Thus, my argument is less about agreeing with the fact that now is the right time to discuss this issue, rather than "when the time comes" as was said by pynner and which I firmly agree with. Rather, my concern would be more about the use of language and the tendency to change standards in a time of crisis. There is certainly precedence for changing standards of behavior or interpretations of words, laws, etc. in times of crisis.

Just my $0.02 worth.

Woody

Existing news thread here:
www.abovetopsecret.com...

Please add to the ongoing discussion.

Thank you.



-thread closed-