Blog | Friday, May 9, 2008

Are you ready to play God?

Disaster planning has been a hot topic in medicine lately (see here and here for our coverage), but a group of physicians known as the Task Force for Mass Critical Care has taken the preparations to a whole new level. In a recent report, they offer specific suggestions on which patients should be left to die if an emergency were to cause a scarcity of critical care resources.

The full recommendations are available in Chest, but here are some of the key points: in addition to the more obvious categories such as cardiac arrest not responsive to electrical therapy, the first patients to lose care include people over 85, patients who have suffered severe trauma, and anyone with severe baseline cognitive impairment.

Obviously, such calculations are impossibly difficult to make, and that's why this group of government and academic leaders wants to save regular docs from having to decide. But it's interesting how far their choices stray from traditional disaster response (elderly get the first spots in the lifeboats) and current political correctness. So far in fact, that a law professor interviewed by the Washington Post noted that the recommendations would likely violate federal anti-discrimination laws which protect older and disabled Americans.

The report raises a lot of questions: Should likelihood of healthy survival be the criteria for deciding who receives care in a shortage? Are hard and fast rules the answer, or do these decisions need to be made on a case-by-case basis? And the dilemmas only get tougher from there. The authors of the recommendations noted that "the area most desperately in need of future study" is pediatric triage.