Utilitarianism: the belief that a morally good action is one that helps the greatest number of people (Merriam Webster online dictionary)
This post is a heavy one but I want to write about it. Here goes:
I recently read in an LA Times Newsletter the latest guidelines put forth from the State Public Health Department about rationing care and ventilators if we are hit with an overwhelming number of hospitalized COVID-19 patients. I found some of it disturbing because they put in an addendum about intensive care and ventilators related to age of the patient. It made me want to research the ethics related to this determination. I did find some discussion of ethical guidelines at The National Catholic Bioethics Center which mentioned certain criteria as “unjust and discriminatory: age (e.g., prioritizing “youth”), disability, race.”
LA Times reporting on California Department of Public Health Guidelines for rationing care during COVID-19. Here are some of the guidelines:
‘The Department of Public Health said the guidelines are meant to serve as a framework for healthcare facilities as they shift from regularly providing optimum care for the individual patient to “doing the greatest good for the greatest number” of patients as staff, beds, medication, equipment and other resources become scarce across the state during a crisis, according to the document….An appendix to the guidelines on “ventilator management” calls for hospitals to give patients a priority score and determine who will receive intensive care with a focus on “saving the most lives and saving the most life-years.”….If there are not enough resources to treat all patients with the same score, the guidelines suggest hospitals group patients by age — 12 to 40, 41 to 60, 61 to 75, and older than 75 — and treat younger people first.’
From ‘Summary of Triage Principles and Applications for Catholic Healthcare Organizations‘ by John A. Di Camillo PHD Staff Ethicist (The National Catholic Bioethics Center)
“There must be no unjust discrimination on the basis of age, disability, cognitive function, quality of life, stage of life, or other value-laden or utilitarian criteria reaching beyond short-term clinical prospects of recovery or mortality and certain limited, unbiased, nonclinical criteria when clinical situations are equivalent.”
He states under his triage criteria:
Triage priority levels should not be affected by considerations of long-term survival, “life-years,” life stage considerations, or similar criteria based on considerations extending beyond the short-term crisis period.
And…When clinical considerations among different patients are equivalent, priority may be given rarely on the basis of certain unbiased considerations.
“…the dignity of the human person must continue to be foundational even as the role of the common good comes into sharper focus. It must be recalled that the common good cannot be achieved by disregarding the dignity of the individual, as utilitarian ethics do. The common good, properly understood, upholds the dignity of each individual.” (Di Camillo)
Additional paper by Rev. Tadeusz Pacholczyk, Director of Education National Catholic Bioethics Center on ‘Thinking Through the Rationing of Ventilators’
This (below) is where the ideas about rationing with age criteria being included came from:
A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic by Douglas B. White MD MAS; Bernard Lo MD. This framework was based on the opinion of these two medical ethicists MDs and now being adopted in some states, including mine, and promoted.
It would be terrible to have to make these decisions to ration ICU beds and equipment. My feeling is we should be sure that there are not ‘unjust and discriminatory’ practices in use.