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Who should MDs let die in a pandemic? Report offers answers
By LINDSEY TANNER, AP Medical Writer Mon May 5, 9:47 AM ET
CHICAGO – Doctors know some patients needing lifesaving care won’t get
it in a flu pandemic or other disaster. The gut-wrenching dilemma will
be deciding who to let die.
Now, an influential group of physicians has drafted a grimly specific
list of recommendations for which patients wouldn’t be treated. They
include the very elderly, seriously hurt trauma victims, severely burned
patients and those with severe dementia.
The suggested list was compiled by a task force whose members come from
prestigious universities, medical groups, the military and government
agencies. They include the Department of Homeland Security, the Centers
for Disease Control and Prevention and the Department of Health and
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
“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
_Those with a severe chronic disease, such as advanced heart failure,
lung disease or poorly controlled diabetes.
Dr. Kevin Yeskey, director of the preparedness and emergency operations
office at the Department of Health and Human Services, was on the task
force. He said the report would be among many the agency reviews as part
of preparedness efforts.
Public health law expert Lawrence Gostin of Georgetown University called
the report an important initiative but also “a political minefield and a
The recommendations would probably violate federal laws against age
discrimination and disability discrimination, said Gostin, who was not
on the task force.
If followed to a tee, such rules could exclude care for the poorest,
most disadvantaged citizens who suffer disproportionately from chronic
disease and disability, he said. While health care rationing will be
necessary in a mass disaster, “there are some real ethical concerns here.” James Bentley, a senior vice president at American Hospital Association,
said the report will give guidance to hospitals in shaping their own
preparedness plans even if they don’t follow all the suggestions.
He said the proposals resemble a battlefield approach in which limited
health care resources are reserved for those most likely to survive.
Bentley said it’s not the first time this type of approach has been
recommended for a catastrophic pandemic, but that “this is the most
detailed one I have seen from a professional group.”
While the notion of rationing health care is unpleasant, the report
could help the public understand that it will be necessary, Bentley said.
Devereaux said compiling the list “was emotionally difficult for everyone.”
That’s partly because members believe it’s just a matter of time before
such a health care disaster hits, she said.
“You never know,” Devereaux said. “SARS took a lot of folks by surprise.
We didn’t even know it existed.”