Who Should MDs Let Die in a Pandemic? Report Offers Answers

Much self-selection will take place. Before triage happens people have to find the aid station.

I think that in an acute crisis we can rely on medical professionals to conduct triage based on a rational criteria with which most of us would agree (e.g. the list Phoenix cites).

I think, as has been suggested, though that we can also rely on power and wealth to be inserted into the criteria, regardless of what ethicists might argue for or against.

Given a limited supply of a cure, and a particularly virulent and deadly disease, some portion of the affected population will die. The only way that the cited criteria might be sufficient is if the cure supply was extensive enough so that the majority of the population could be saved.

As long as there is enough of the cure supply to require numerous distribution points with numerous persons involved at each point, wealth and power will be able to corrupt and/or coerce as necessary to bend or break whatever regulations have been put in place.

Reduce the supply and/or increase the affected population, and the criteria for determining the sacrificed will broaden. There is no criteria, under any scenario, which will be accepted by 100% of the populace, but as the number of the sacrificed grows, the acceptance of the criteria for identifying them will decrease.

Most of us will agree that age would be a rational criterion, and I suspect that most of us will also agree that 85 is a reasonable cut off point. However is this because most of us appreciate that people of this age have already enjoyed more years that most people get, and are not likely to be as productive as younger members of society, or because most of us are younger than 85 and don't have any family or friends of this age?

Reduce the cure supply and increase the number that must die and consider whether or not it is rational for someone aged 65 or older to join the ranks of the sacrificed, or someone with a chronic disease or total disability.

As the criteria broadens the influence of wealth and power will intensify but wealth, alone, will be effective only up to a certain point.

In a scenario where the majority of the population cannot be saved and will die, the conventional rules of our society will break down. Certainly the economy will utterly crash and common notions of wealth will drastically change. Someone with access to the cure is not going to risk their life (for under this scenario pilferage would most likely be a capital offense) for millions of worthless pieces of paper.

In such a scenario the voluntary acceptance of societal rules that we so heavily rely upon every day to maintain general order will be in short supply, and whatever rules are in place will need constant and conspicuous might to enforce.

No matter what, the criteria applied will be drastic. If we're lucky it will be established and applied by a source of power that is interested in preserving some model of our civilized society, otherwise its back to the Dark Ages and starting all over.

People have a very distorted sense of risk and reward, and really are pretty lousy at measuring the relative likelihood of either. You are far more likely to die in a car than an airplane, yet there are people who will drive cross country rather than fly. People who inhale cigarette smoke worry about global warming, and the guy who is 150 lbs overweight and scarfing down a Big Mac, may very easily be losing sleep over a bird flu pandemic.

At the same time, although it is not sensible to worry about a pandemic, let alone one that devastates the population of this country, one is entirely possible and could begin tomorrow.

Dinosaurs lived for millions of years, a length of time that it inconceivable to us and renders human history into a relative moment, and yet there were actually some unlucky saurian SOBs grazing the prairies when the asteroid hit. Someone has to be the last one standing.

The solution to the triage question is really quite simple: save the rich first.

With 6 billion people on earth I wouldn't worry about saving people. The over population brings about disease due to waste production and the resulting unsanitary conditions. Scarce resources brings about war, famine, starvation and pandemic diseases. It is natures way of culling excess humans. It would be up to nations to best select whom would be most beneficial for the nation to function well. Individuals with plenty of money could use their wealth to preserve their families and institutions such as corporations would like their critical employees to be kept in good health, etc.

The concept of saving the rich is similar to that old story about a ship that is going to sink, which would mark the end of humanity. There is one small lifeboat that will hold only a few people. The question that is asked is which people would be most valuable to save. IMO it would be those who are most capable of rebuilding a society.

Certainly, in a pandemic, those people who have lived their lives off the largesse of others would not fall into that category. Nor would rich playboys who have done nothing on their own but spend their parents' fortune.

Is that how you define all of the rich?

So, with a pandemic - like the influenza pandemics 1917, 1957 and 1968 - no rich playboys nor those on social benefits should be saved but .... who else?

No one but the rich will decide to save the rich, but unlike other groups that wish might to save themselves, the rich can.

[quote]The question that is asked is which people would be most valuable to save. IMO it would be those who are most capable of rebuilding a society[/quote].

Mysteryman- Did you read what I wrote?

let's read the heading again , please .
there would be many unknowns if a pandemic were to take place that imo it would be difficult if not imposible to forecast what action should be taken .

the ontario health units have drawn up some plans on how to act in an influenza pandemic . all health workers and those working in public utilities - electricity , water and gas - are to be attented to first , but that assumes that enough health workers would even be qvailable to offer aid .
people working in food distribution are also high on the list - trucks would be asssigned to drop off food on the streets for people to pick up - if they can still make it out of the house and back !

the disaster in china - which is not even a pandemic - shows the difficulty of what to do first . do you concentrate on rescuing individuals or do you concentrate on clearing roads to allow more rescue personnel to come in .

in a true pandemic or natural disaster , many decisions will have to be "seat of the pants" , because there is often no rule book that can be followed .
toronto's SARS outbreak showed how difficult it is to act when being hit by an "unknwn" . while relatively few people died in the outbreak , it took weeks to fully identify the virus and develop the proper strategies to deal with it .

last week when a women died on a trancontinental train in northern ontario and several other passengers got sick with "flu-like" symptons , the full disaster team sprung into action - as it turned out , the woman had died of heart problems and the other five passengers had a mild flu .
everyone breathed a sigh of relief when within 24 hours the puzzle was solved .

i still think when a true and unknown type of pandemic hits , there likely will be no "plan A or plan B " that will give all the answers to the health workers on the spot .
i still think that it is important to practice "disaster recovery" exercises , but i doubt we can be prepared for any and all problems - or we might have to stop all other activities .
just like we cannot put all our resources in disease prevention and cure - there is after all some work most of us need to do to make a living .
hbg

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Mysteryman- Did you read what I wrote? [/quote]

Yes I did.
You made it obvious that anyone on any kind of welfare type program would not be saved, but I was responding to this part...

I've never heard that one, dlowan. Interesting. Is it solely Australian?

They all just like fantasising about being in the power position of deciding who will live and who will not.

I think it's kinky.

I'm no doctor/scientist but I think that a new bug that is able to create a pandemic is going to worry much about a list. By its nature, it'll get those, strong or weak, that don't have the necessary stuff inside to fight it.

It's gonna get a lot of us, no doubt, in more ways than our health. Just imagine for a moment how it's going to affect the economy.

My grandpa nursed a lot of his family thru the 1918 outbreak. He was the only one who didn't get sick. and now that I think about it caused the death of any of my family back then. That seems odd, given how bad it was. More research needed.

Not at all.


Or do you mean "cark it"? Don't know where that comes from.

If/when we have the bird-flu pandemic, it is posited to be so severe that all these cute plans will break down.

For instance, if it acts like the 1918 flu pandemic, it will selectively strike down those with the strongest immune systems (ie the young and fit), because the very strength of their immune response was exploited by the virus to make it more virulent than it was amongst those with weaker immune systems.


Just look at who staffs ambulance services, frontline ER departments, police services etc.


Many of those who would be key in responding would die, or be too ill to respond. A massive breakdown in response services is being posited as a given in response plans. (I work in a hospital, so I see these plans.)


Many will not even get to medical help, if these suppositions prove accurate.


So it goes.

Yup, I meant 'cark it', dlowan. It seems that you've used it as a synonym of 'die'. Can it be used in a passive sense like 'kill' is, as in,

They were carked by the tornado/bird flu.

This is a very interesting topic of discussion. IMO a list of guidelines would be extremely helpful in a disasterous situation. This will take a lot of pressure off of health care personell rushing to make life and death choices while working, I'm sure long hours with little rest.

But as others have noted, this is in a pandemic situation. These things aren't considered in daily life saving situations unless a living will is in place.

I work in an interventional lab and we do diagnositic procedures as well as life saving procedures. When we have a prisoner escorted by uniformed officers our questions are not why this person is incarcerated. Our focus is providing every patient we see with the same quality of care. Or even the 98 year old stroke patient who is in complete vegitative state who is in need of nutrition to stay alive, these patients receive feeding tubes with the same quality of care as the patient with throat cancer who is undergoing chemotherapy with a chance of survival.

I'm guessing that young Children Without Adults are going to get lost in the shuffle, accidentally or deliberately.

The answer is: those least likely to do the most good should be the ones MD's let die first in a pandemic.

The original question assumes that there is something doctors can do to either cure or increase the chance of survival for a given patient.

If nothing can be done for anyone, then of course each individuals natural immune system will determine his or her fate.