A lottery for ventilators? Hospitals prepare for ethical conundrums

3/28/2020 12:00:00 PM

While some states have ethics guidelines in place, there is no national standard for who gets access to scarce life-saving machinery.

As New York and other states gird for the possibility of a shortage of ventilators, ethicists wonder if a lottery will be the fairest option

While some states have ethics guidelines in place, there is no national standard for who gets access to scarce life-saving machinery.

ethical guidelines for allocating ventilators in a pandemic, they coalesced around a clear principle: Scarce resources should go to the person most likely to be saved.Outbreak Today.Sean Hannity President Donald Trump told Fox News host Sean Hannity on Thursday evening that he believes that the coronavirus battle will not require the number of medical equipment that have been requested by some states.Photo: Drew Angerer/Getty Images Hospitals in New York, Detroit, and Atlanta are at or above their capacity, with growing numbers of coronavirus patients pouring in.

But they had to contemplate another, tougher, situation: What if a number of patients were equally likely to benefit? In that case, they decided, a lottery might be the fairest option.Advertisement The specter of such extreme rationing – a large number of critically ill patients confronting a finite supply of life-saving machinery – was grim but theoretical when debated by the philosophically minded panel.Earlier in the day opposition MPs had criticised the government for not joining forces with EU countries to get more of the devices, which are used to help people breathe by getting more oxygen into their lungs.Now, as New York and other states gird for the possibility of a shortage of ventilators, that ethics roadmap could come actually into practice."Really? What am I going to do with 40 ventilators when I need 30,000?" President Donald Trump said Thursday he doesn't believe U.Even scarier is the prospect confronting many other states which could also see coronavirus overwhelm their hospitals: No guidelines at all.A spokesperson for Prime Minister Boris Johnson that the UK would not participate because"we are no longer members of the EU".“We haven’t had a national conversation about how we are going to prioritize,” said Ezekiel Emanuel, a physician-ethicist now at the University of Pennsylvania who was a health adviser to President Barack Obama.“Some government officials,” reports the Times, “expressed concern about the possibility of ordering too many ventilators, leaving them with an expensive surplus.

“We are not prepared for triage.The UK left the EU on January 31 but is still following almost all EU rules and regulations as part of a “transition period”.Drew Angerer/Getty "I have a feeling that a lot of the numbers that are being said for some areas are just bigger than they're going to be," Trump said.” Among hospitals around the country, there are widely accepted basic ethical principles on establishing priorities for health treatment, and dozens of bioethics and pandemic planning reports that stress directing scarce resources to patients likely to benefit.But there’s no uniform, national framework for emergency rooms across the country to turn to in crisis.“Owing to an initial communication problem, the UK did not receive an invitation in time to join in four joint procurements in response to the coronavirus pandemic,” a spokesman for the prime minister said on Thursday.Only a few states have worked out their own guidelines, with hard-hit New York and Washington state among them.All of a sudden they're saying, 'Can we order 30,000 ventilators?'" "Look, it's a very bad situation," the president continued.New Jersey, another hot spot, rushed to set up an advisory committee just this week.“As those four initial procurement schemes had already gone out to tender, we were unable to take part in these but we will consider participating in future procurement schemes on the basis of public health requirements at the time," the prime minister's spokesperson said The news emerged during the UK government’s daily press conference, as ITV Political Editor Robert Peston tweeted the statement while Chancellor Rishi Sunak was announcing measures to financially help people who are self-employed.“A lot of equipment is being asked for that I don’t think they will need,” Trump said.

“That is, I would have to say, one of the more difficult issues we will be discussing,” New Jersey Health Secretary Judith Persichilli said of potential ventilator shortages.As of Thursday evening, no one had been denied a ventilator because of a capacity shortage, even in the jam-packed hospitals of New York, White House response coordinator Deborah Birx stressed." Related Stories.There’s an urgent scramble to buy more, build more and better allocate those available – although President Donald Trump told Fox News he had “a feeling” the shortage was exaggerated.Nonetheless, public-health experts said many hospitals have inadequate guidance – legal or ethical – to develop protocols on who gets priority.“These are topics we don’t like to talk about – triage, resource allocation, extreme scarcity,” said Nancy Berlinger, a prominent bioethics researcher at the Hastings Center , state-based think tank , who is working on a more consistent national approach.The reason is that the coronavirus leaves many victims unable to breath, and they will die without a ventilator machine.

“We don’t have coordination across the country or at the state level.Hospitals and health systems are trying to figure it out for themselves.” Addressing that need, Emanuel and a team of fellow bioethics experts recommended in a New England Journal of Medicine article that hospitals and emergency departments put in place real-time rapid response teams – scaled down, souped-up versions of the standard hospital ethics committee reviews.Acting on a compressed timeline, these clinical triage experts can make tough decisions – sparing the bedside physicians from deciding on their own whether the patient in front of them lives or dies.That’s a haunting emotional burden which the world has seen Italian doctors experience.In Europe, overflowing hospitals have already been forced to ration their ventilators and decide which patients will receive the life-saving equipment.

Guidelines aren’t a simple checklist, and there’s no arbitrary cutoff based on age alone.New York’s guidelines, which were developed for flu but applicable for Covid-19, are nearly 300 pages.They are not mandatory but offer a framework.They say that to save the most lives “patients for whom ventilator therapy would most likely be lifesaving are prioritized.” That recognizes that ventilators aren’t miracle cures; some people in poor health could stay on a ventilator for weeks and still die, while someone with better odds doesn’t get access.” They are pausing to haggle over the price, rather than just agreeing to this deal and then hiring other companies to produce ventilators.

So the breathing machines should go to the patients most likely to benefit.The New York report concluded that when multiple patients are equally likely to recover, but there are limited resources to help them, hospitals “utilize ‘random selection’ (e.g., lottery) methods.” The panel concluded that a lottery was more equitable than treating people on a first-come, first-serve basis, which could disadvantage “those who are of lower socio-economic means who may not have access to information about the pandemic or to reliable transportation, or minority populations who might initially avoid going to a hospital because of distrust of the health care system.But it seems quite likely that the Trump administration is haggling over relatively trivial sums, denying a crisis, and sending Americans whose lives might have been spared to horrible deaths.

” Given how little ordinary Americans prepare for end-of-life care, the Trump-fanned currents of distrust in science, and the hangover from the false “death panel” narrative of Obamacare, there’s lots that can go wrong in approaching the question of who gets priority for ventilators.Indeed, Betsy McCaughey, a historian turned conservative health policy commentator who was one of the Obamacare critics associated with the false “death panel” attacks, is blaming any eventual coronavirus-related rationing on Gov.Andrew Cuomo’s mismanagement.In one New York Post article, she referred to ethics experts as “triage officers” and added, “In truth, a death officer.Let's not sugarcoat it.

” “It won't be up to your own doctor,” she said.In fact, people’s regular doctors would seldom be directly involved with a patient’s care in ERs and ICUs.Ethicists also agree that wealth, socio-economic status, or the ability to pay for care shouldn’t matter.And that policies have to be transparent.But some Americans, anxious about their own family’s susceptibility to Covid-19 and confused by the mixed messaging from government, may be skeptical about whether the system really treats everyone fairly -- particularly after celebrities, athletes and politicians got access to coronavirus testing when very sick ordinary Americans could not.

“It’s got to be fair and transparent,” said Diane Meier, a geriatrician and palliative care doctor who directs the Center to Advance Palliative Care.A clinical triage team making decisions shouldn’t even know whether the patient is a homeless person or the president.A lack of ventilators may be capturing public attention right now but it’s not the only ethical issue that could confront hospitals and caregivers.Coronavirus is a brutal disease that causes respiratory distress; those whose lives it takes do not go gently into the night, said Joanne Lynn, a nationally known geriatrician who does aging policy at the Altarum Institute.CORONAVIRUS: WHAT YOU NEED TO KNOW that will give immediate assistance to many Americans, small businesses and major industries near collapse.

Confirmed U.S.Cases:.

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More lies and panic headlines! Stop spreading this stuff, media is becoming the grim reaper. Has it happened yet? Answer is NO. Post facts. This is opinion because you have no idea what will happen. Start spreading hope while telling people to be cautious. spin the wheel of misfortune Why not name the hospitals that are out of ventilators-Not one has been named! People need to know which hospitals to avoid

No, if you’re over 80 you’re dead, give it to younger people obviously Jesus Christ, how about those ethicists consider discussing how and who got us into this mess already? How about that? Absolutely not. The data should drive the need. Beef up the supply now and distribute according to real time need.

No. Medical professionals should triage and prioritize care. Doctor birx said yesterday we. Aren't at that point A competent President would be useful.

A 'Communication Issue' Means The UK Hasn’t Been Working With The EU To Get More VentilatorsIn severe cases of the coronavirus, hospitals use ventilators to help people breathe. The Joys of Brexit

sounds like the hungergames is becoming real? Ethicists know that when there is a shortage options are based on chances of success not random luck

Trump claims U.S. states don't need the amount of ventilators they're asking for: 'I don't believe you need 40,000 or 30,000''You know, at a major hospital sometimes they'll have two ventilators,' Trump said. 'All of a sudden they're saying, 'Can we order 30,000 ventilators?'' كذاب و كاذب Forgot he was one of the greatest medical minds we’ve ever seen. 🤦🏻‍♂️ Covid-19 is either 1) really bad, knock one down, flu-like symptoms or 2) it's that, then it quickly/fully attacks the lung tree. The pressure of the vent needed 4 oxygenation levels is such it could almost burst some lungs/trachea/cause lifelong lung damage.

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