Imagine holding hundreds of patients' lives in your hands, being forced to choose who lives and who dies.
Many doctors at hospitals around the nation are being faced with such a grueling decision. Specifically in hotspots such as New York and Washington, exponential growth in COVID-19 cases is predicted to cause severe shortages of equipment, supplies, and staff. Without protective equipment, healthcare workers themselves are now at risk. Once all of these resources are depleted, how do medical providers decide who lives and who dies? How can these choices be justified?
In Italy, doctors have been forced to withhold ventilators from older and sicker patients to save younger and healthier ones. Can and should a similar strategy be employed in the US? One can claim that such an effort would minimize years of potential life lost (YPLL), a critical indicator of community health and strength in the field of public health. However, an opposing argument could state that a younger person does not have the life experience or financial state to be a positive contributor to society and economy. This method may also inadvertently place bias against patients with disabilities, as well minority groups who are disproportionately affected by certain underlying health conditions such as diabetes. These minority groups and immigrants have also historically received less quality healthcare in general, impairing their immune system and physical health and decreasing their chances of improving their condition.
Sharing resources between patients by rotating equipment may provide everyone with equal opportunity. However, it can also be more detrimental than choosing to treat certain patients over others. If patients are provided with ventilators for only a few days before losing it to someone else, potentially none of the patients will receive adequate treatment, resulting in more deaths than if a certain cohort received prolonged treatment. Discharging patients earlier in order to open more beds is another similarly risky suggestion. Though initially seeming to have improved symptoms, many patients worsen at home without treatment.
In attempts to avoid rationing, medical institutions are training staff to work in new roles outside of their usual job, increasing responsibilities of medical school students and residents, and postponing non-essential services (i.e. elective surgeries). The coronavirus has brought our nation to a completely unexpected apocalyptic state. We were unprepared for the surge in cases, and it is now harshly evident. The healthcare field is working tirelessly to save citizens' lives, being forced to deal with rarely encountered ethical dilemmas. Doctors, nurses, PAs, nurse practitioners, EMTs, paramedics are all putting their lives and the lives of their families at risk to treat Americans. They deserve not only endless gratitude, but all of our help, too.
There is only one way to stop the spread and save lives. Do your part. Stay at home.
