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Planning for Pandemic: Who Lives, Who Dies and Who Decides?

Oct 06, 2009
By Greg Emerson Bocquet


Hazel Ribron waits at Baylor University Medical Center in Dallas, Texas where her husband is on life support. Photo by Sonya N. Hebert/Newscom

Floods, hurricanes, earthquakes, anthrax attacks: if the United States were a 233-year-old on Medicare, the past few decades would have seen her take repeated visits to the emergency room. As a potential swine flu pandemic threatens to send the nation back to the hospital this fall, our understaffed and under-equipped emergency rooms are forcing crisis planners to make some difficult choices about rationing care.

In June, the U.S. surpassed Mexico with the highest number of infections and deaths from the H1N1 virus, and with expectations of a continued increase in the pandemic, the death toll from swine flu will likely be magnified by delays in production of the H1N1 vaccine and a drastic shortage of ventilators.

New York has proposed a triage system aimed at saving the most lives possible by requiring that some patients be removed from life support in order to help those with a greater potential of survival. Clearly, such a plan—which may be a bellwether for others—raises a host of difficult questions.

Patients and their families typically control end of life decisions, as reported in FLYP’s “A Matter of Life & Death,” and even with some time to prepare, the choices are never easy.

In a crisis, however, those choices typically rest in the hands of stressed out doctors and nurses struggling with limited resources. With the response plans being drawn up in New York, Minnesota, Utah, and Colorado, however, officials are trying to take the decisions out of the hands of overworked caregivers in understaffed crisis centers by establishing a hierarchy of people to whom ventilators would be given.

Is that legal? Right now, in New York at least, a doctor is prohibited from removing a patient from life support unless they or their family have decided to do so through a living will or advance medical directives. As ProPublica reports, “New York officials are studying possible legal grounds under which the governor could suspend a law that bars doctors from removing patients from life support without the express consent of the patient or his or her authorized health agent.”

While people make these choices every day, the game changes when the choices are being made for them. A set of official guidelines may help doctors make those calls more easily, but this season’s debate about end-of-life counseling suggests that the public will not take kindly to any government representative having a say in who lives or dies.

In the case of a pandemic, though, they may not have a choice. While individual families have choices they can make at the end of a loved one’s life, responding to a full-fledged flu pandemic would require a protocol that covers everyone.

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