With the raging coronavirus pandemic threatening millions with infection, people are rightly worried that we could face the awful circumstance in which there are insufficient life-saving medical resources available for all catastrophically ill patients needing care. If that dark day comes, decisions will literally have to be made as to who among the seriously ill will be given an optimal chance to fight for life under intensive medical care, and who may have to face a likely death, albeit under palliative care.
All over the country, doctors, bioethicists, policymakers, hospital administrators, and media commentators are discussing how to make such extremely difficult decisions if they become necessary. That’s proper and fitting. As the old saying goes, hope for the best and plan for the worst. Moreover, it is wise to create a well-thought-out plan that can be followed consistently in awful contingencies to prevent ad hoc approaches that invite life-and-death decisions to be based on cronyism, discrimination, or other unjust non-medical factors
If doctors must refuse needed care, morality and maintaining the people’s trust require that they always be executed in a manner wholly consistent with upholding the equal moral worth of all patients. In other words, decisions to withhold or withdraw treatments — chance for life or likelihood of death — should never be predicated on invidious distinctions, such as race, sex, wealth, age, sexual orientation, disability, etc. Or to put it another way, each patient who enters the regrettable to treat or not to treat decision-making process must do so as the inherent equal of every other patient.
In this regard, we should distinguish between “triage” — which is ethical — and “health-care rationing,” which, as I use the term in this article, is not. Triage involves doctors or other medical professionals assessing the differing chances for survival among patients who would all be eligible for extensive treatment, but all of whom can’t be served because of resource limitations. In that circumstance, those patients with the greater likelihood of surviving the crisis because of the intervention will receive priority in receiving treatment over those more likely to die even with care.
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