News & Insights
Apr 1, 2020
The Department of Health and Human Services recently released a letter that stated that using a single ventilator for two patients should be considered “an absolute last resort.” Of course, this statement assumes that a ventilator exists in the first place, and it says nothing about how to deal with several more than two patients needing the same ventilator.
This, however, is only the tip of proverbial iceberg.
These are extraordinary times in the truest sense of the word. As the COVID-19 pandemic unfolds, there already have been and there will certainly be more issues that raise ethical concerns. As with many ethics issues, there can and will be debate about how to address these issues. Regardless of the specific issues to be addressed or the ultimate decision that are made, most people would agree that decision-making in advance is better than decision-making under duress, stress and fatigue.
To this end, providers and health planning entities are encouraged to consider the following, among other things, as soon as possible, and hopefully before they present themselves:
The above reflect only a fraction of the real-life scenarios that are likely to present themselves as we all respond to the COVID-19 pandemic (and in the case of other catastrophic situations that call for simultaneous acute care and public health interventions within a context of limited resources). Among other complications, these questions involve a blend of legal, financial, practical, micro, and macro concerns.
Aside from the above institutional questions, there are myriad considerations of what each of the individual states (and other countries) are doing about rationing of healthcare, if anything. For example, the authors of this piece are located in Virginia, and as of the date of this publication, the Commonwealth has declined to provide any rationing guidance in the event demand exceeds supply. Obviously, it remains to be seen how this situation will unfold, but it appears likely that each state will take its own approach to healthcare resource allocation, just as they have for social distancing protocols. As a result, the various states will inherently become ethics “laboratories.” As different results emerge from these laboratories, we are bound to see an evolution in the response to the current crisis, which should also inform our response to crises in the future.
For each of the above, the “right” answers or, perhaps, the “least bad” answers are likely to take different forms. Waller’s team can assist in taking a deliberate approach to advance decision-making and can provided invaluable critical distance for decision-making in the heat of the moment.
Nathan Kottkamp has a Master’s Degree in Bioethics and is the founder and chair of National Healthcare Decisions Day, a nation-wide advance care planning event.
Molly Huffman is a healthcare attorney, routinely advising hospitals and health systems on a wide array of issues, including risk, compliance, end of life decisions, and related matters.
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