Sheri Fink at The New York Times on “Choosing Who Survives in a Flu Epidemic“:
New York state health officials recently laid out this wrenching scenario for a small group of medical professionals from New York-Presbyterian Hospital:
A 32-year-old man with cystic fibrosis is rushed to the hospital with appendicitis in the midst of a worsening pandemic caused by the H1N1 flu virus, which has mutated into a more deadly form. The man is awaiting a lung transplant and brought with him the mechanical ventilator that helps him breathe.
New York’s governor has declared a state of emergency and hospitals are following the state’s pandemic ventilator allocation plan — actual guidelines drafted in 2007 that are now being revisited. The plan aims to direct ventilators to those with the best chances of survival in a severe, 1918-like flu pandemic where tens of thousands develop life-threatening pneumonia.
Because the man’s end-stage lung disease caused by his cystic fibrosis is among a list of medical conditions associated with high mortality, the guidelines would bar the man from using a ventilator in a hospital, even though he is, unlike many with his illness, stable, in good condition, and not close to death. If the hospital admits him, the guidelines call for the machine that keeps him alive to be given to someone else.
Would doctors and nurses follow such rules? Should they?
Something’s being slipped in here that the Times seems not to notice: The scenario apparently posits confiscating the patient’s own ventilator, his personal property, for public use.
I’m just going to say right now that such confiscation ought rightly be utterly abhorrent, that the possibility ought not even be in training scenarios except as an absolutely not! example. And yet the Times slips it in without comment, as if to say, “Well, of course that’s a reasonable option.”
No, ma’am, no it’s not.
This article, and the scenarios it discusses, also fail to take into account a principle John Ringo makes much of in his novel about a catastrophic epidemic, The Last Centurion:
Emergency plans always leave out the emergency.
We are given the impression that these decisions will be made in the context of an unusually busy Saturday night in the ER, that people will be sitting around a conference table, or at least clustered around the nurses’ station, coffee cups in hand, spending a few moments discussing the file of each patient coming up for review….
If things have gotten to the point justifying the imposition of real triage rules, much less the confiscation of private property, here’s what’s going on:
The vaccine distribution plan has already failed. For whatever reasons, and government stupidity is likely to be a dominant factor, the vaccine did not protect enough people to contain the disease.
Half the hospital staff is either dead or dying, bunkered down with their families, or have fled the city. The remaining staff have not slept more than two hours in the last forty-eight. The Benzedrine ran out two hours ago.
There is a riot brewing outside the hospital among people demanding treatment.
The cops, if any, are occasionally firing on rioters who press the doors too closely.
Ventilator Guy’s appendix has already burst because he could not get to the hospital, and his ventilator is inflating the lungs of a dead man — if there is even power to run it.
Remaining staff is deciding, moment to moment and essentially on personal whim, who gets saline and bandages, because those are the only resources the hospital has left to allocate. The pharmacy was ransacked yesterday.
You want natural childbirth? You think anything else is even on offer? Women are pushing babies out while lying on the floor, attended by their husbands or other new moms. Or alone, in alleys, as nature intended.
Meanwhile, the flickering TV monitor in the ER waiting room shows a grim but calm President reassuring his people that everything is under control, and if people will simply follow CDC guidelines….