Is it Right to Base Care on Expected Longevity?

Pandemics Force Doctors to Make Difficult Decisions

When hospital resources are stretched too thin, doctors and hospital administrators face the dilemma of who should receive life-saving care. This issue has been front and center in Tennessee lately thanks to the novel coronavirus, which has swept through the population and continues to surge even as we approach late summer.

In other countries, like Italy, hospitals were overwhelmed during the peak of the COVID-19 crisis. There were not enough beds in the intensive care unit nor were there enough ventilators for those who needed them.

Health officials in Tennessee prepared guidelines on who would receive life-saving treatment in such a scenario, but a federal lawsuit challenged the regulations, prompting the state to revise them. Today, the ethical dilemma persists.

New Guidelines

The state guidelines that were challenged in a federal lawsuit would have considered several factors, including:

• How likely the patient was to respond to the treatment and immediately survive the illness.
• The patient’s long-term survival, i.e., how many more years they had left.

These are not the same considerations. For example, an older person who is in excellent health might respond well to treatment even if they do not have as many years left to live as, say, a 30-year-old.

Under the new guidelines, medical professionals are to consider only the first factor—the patient’s likelihood of surviving the immediate illness. They cannot consider a patient’s long-term survival prospects. This change still allows treatment to be targeted to those most likely to respond to it.

The updated guidelines also eliminated a categorical exclusion that applied to people with certain medical conditions, such as spina bifida. Now, someone with these conditions can still qualify for care.

Potentially Discriminatory

Many critics also charged that the old guidelines were racially discriminatory. Many African Americans and other ethnic minorities have more underlying medical conditions, such as diabetes or heart disease, that reduce their life expectancy. Denying them treatment could constitute racial discrimination.

Of course, those with underlying medical conditions are also less likely to survive many illnesses, including COVID-19. According to the government, people with diabetes, heart disease, and obesity are more likely to come down with “severe” illness, which increases their odds of death. So, even under the new guidelines, they might not receive equal treatment since they have a reduced chance of responding positively.

State Can Still Deny Care

The updated guidelines still envision situations where demand for medical resources outstrips their supply. For this reason, a hospital is still empowered to remove a ventilator from someone who is not showing improvement, even without the patient’s consent. Doctors can then give the ventilator to someone who needs it.

We hope hospitals never have to make these difficult decisions. The good news is that these guidelines are not in effect when medical resources are readily available. Nevertheless, pandemics strike unexpectedly, and hospitals need a plan in place that allows them to save the greatest number of people with limited resources.

At Burch, Morrison, & Stewart, our personal injury attorneys fight for the maximum compensation for our clients. Please contact us if you would like to schedule a free consultation.