Hospitals, States Consider How to Distribute Healthcare if Coronavirus Surges
Among the goals of Colorado's state plan is to “minimize serious illness and death by administering a finite pool of resources to those who have the greatest opportunity to benefit from them”.
WASHINGTON, D.C. — In Italy, which has the most deaths from coronavirus, some doctors have said they have had to overlook older patients to focus on younger ones who are more likely to survive as the virus overwhelmed the healthcare system.
In the US, states and hospitals are considering how to distribute healthcare if demand for limited resources exceeds what can be provided. Worldwide, there are 332,930 confirmed cases of Covid-19, and 14,509 deaths. Of those, 31,573 cases are in the US, where there have been 402 deaths due to the virus.
Colorado adopted a Crisis Standards of Care Plan in 2018 as guidelines “to assist healthcare providers in their decision making with the intention of maximizing patient survival and minimizing the adverse outcomes that might occur” when healthcare needs “far surpass” what is available.
“It’s very military-style triage,” Dr. Matthew Wynia of the University of Colorado Anschutz Medical Campus told The Colorado Sun's John Ingold. “If we get hit that hard, we are going to have some very difficult decisions to make. And we can’t wait until then to get ready for that … it would be irresponsible not to plan right now for a huge surge of patients.”
Colorado's crisis standards of care would be activated only after the governor declares a public health emergency, and even then, it would implemented locally, depending on the conditions in individual counties or communities.
Among the goals of the state plan is to “minimize serious illness and death by administering a finite pool of resources to those who have the greatest opportunity to benefit from them”.
Guiding ethical elements of Colorado's plan are stewardship of resources, duty to care, soundness, fairness, reciprocity, proportionality, transparency, and accountability.
It focuses especially on fairness, proportionality, solidarity, and being participatory.
The Colorado guidelines say healthcare providers should be fair to all the affected “without regard to factors such as race, ethnicity, socioeconomic status, disability or region that are not medically relevant.”
With regard to solidarity, the Crisis Standards of Care Plan says that “all people should consider the greater good of the entire community.” It adds that for transparency and accountability, “the community, healthcare providers, and emergency management agencies” should be engaged during the process.
Dr. Charlie Camosy, an associate professor of theology at Fordham University, last week discussed with CNA the principles that should be used as doctors might face choices over healthcare distribution.
“There are virtually no universally agreed-upon principles to do this--excepting, perhaps, the idea that health care providers, first-responders, law enforcement, and others primarily responsible for the day-to-day functioning of the polity should get priority,” he stated.
For Catholics, he said that serving “the most vulnerable first” is a fundamental principal.
“Those people are Christ to us in a special way and we will be judged according to how we treat them. We don't think about, say, how long they might stay on a ventilator vs. how long someone we might encounter next week might stay on a ventilator. We also don't think about how long they might have to live if the treatment is successful vs. how long other someone we might encounter next week might live if their treatment is successful.”
He added that it makes sense among limited resources “to treat those first who are most likely to benefit from the treatment. And there may be a disproportionate number of younger people in the former category. But that is not the same as deciding that we ought to prefer the young to the old because they have longer to live.”
While the US bishops' Ethical and Religious Directives for Catholic Health Care Services do not directly address resource allocation during crises, they do note that “Catholic health care should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society and makes them particularly vulnerable to discrimination: the poor; the uninsured and the underinsured; children and the unborn; single parents; the elderly; those with incurable diseases and chemical dependencies; racial minorities; immigrants and refugees.”
The directives add that “in particular, the person with mental or physical disabilities, regardless of the cause or severity, must be treated as a unique person of incomparable worth, with the same right to life and to adequate health care as all other persons.”
In Washington, advocates of persons with disabilities have filed a complaint saying that crisis care guidelines issued by the state health department are improperly discriminatory.
“There's been a long history of people with intellectual, development mental disabilities having our medical care denied," Ivanova Smith, one of the complainants, told NPR. "Because we're not seen as valuable. We're not seen as productive or needed. When that's not true. We have people that love us and that care for us. Many people with disabilities work and they do amazing things in their communities but they need that life saving care."
Attorneys representing the Thomas More Society and the Freedom of Conscience Defense Fund published a memo March 23 urging that “policies rationing care on the basis of disability or age … would violate federal law regarding invidious discrimination.”
“Anticipated longevity or quality of life are inappropriate issues for consideration. Decisions must be made solely on clinical factors as to which patients have the greatest need and the best prospect of a good medical outcome. Therefore, disability and age should not be used as categorical exclusions in making these critical decisions,” the memo concludes.
Peter Breen, vice president of the Thomas More Society, commented that “The horrific idea of withholding care from someone because they are elderly or disabled, is untenable and represents a giant step in the devaluation of each and every human life in America.”
Other possible criteria for healthcare distribution during crises include first-come-first-served, or a lottery system.