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
for allocating ventilators in a pandemic, they coalesced around a clear principle: Scarce resources should go to the person most likely to be saved. But they had to contemplate another, tougher, situation: What if a number of patients were equally likely to benefit?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.
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. Only a few states have worked out their own guidelines, with hard-hit New York and Washington state among them.
Nonetheless, public-health experts said many hospitals have inadequate guidance – legal or ethical – to develop protocols on who gets priority. 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’ methods.”
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.
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