The New England Journal of Medicine ** released an article yesterday on how scarce medical resources could ethicically be allocated when our hospital systems get overwhelmed with COVID19 cases at the end of the week:
These ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the Covid-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all Covid-19 and non–Covid-19 patients…..
However, encouraging all patients, especially those facing the prospect of intensive care, to document in an advance care directive what future quality of life they would regard as acceptable and when they would refuse ventilators or other life-sustaining interventions can be appropriate.
Operationalizing the value of maximizing benefits means that people who are sick but could recover if treated are given priority over those who are unlikely to recover even if treated and those who are likely to recover without treatment. Because young, severely ill patients will often comprise many of those who are sick but could recover with treatment, this operationalization also has the effect of giving priority to those who are worst off in the sense of being at risk of dying young and not having a full life
This article is merely recommendations. It is not operational guidance nor a legal document. But as hospitals are gearing up to face a wave of high need patients who were infected before we started to physically distance from each other, it is guidance that many hospitals and their clinicians will be consulting in the coming weeks.
One of the most important things that we can do as individuals is to update our end of life wishes. Update our wills. Make sure that our medical proxies are able, willing and have at least one back-up. We should also make sure that our kids will have someone to take them in with appropriate back-ups. The medical system is preparing for the worst, and we should do so as well in our personal life.
** DOI: 10.1056/NEJMsb2005114