Ethicists like me have studied rationing for decades. In a few days, our guidelines will be needed.
Rationing occurs in the United States. Anyone on a waiting list for a kidney or liver transplant knows this. But in just two weeks, the need to select which severely ill coronavirus patients will receive treatment — and which will go without — will be more acute than anything Americans have ever experienced or probably imagined. Even in the most favorable scenario, 39,727 intensive-care-unit beds will be needed on April 15, the projected peak date for the covid-19 pandemic in this country. Only 19,864 such beds will be available. There won’t be enough ventilators, either. These projections, from the Institute for Health Metrics and Evaluation at the University of Washington, optimistically assume that social distancing measures are maintained for weeks. The actual shortfalls are likely to be worse.
How should these choices be made? There is no authoritative source of ethical wisdom. But the issues have been examined intensively for two decades, initially as a response to the prospect of an avian flu pandemic. That scenario was frightening enough to prompt authorities to convene task forces at the global, national and state levels to survey available resources, identify shortfalls and set priorities. I participated in deliberations at the World Health Organization and in Massachusetts, both of which gave explicit attention not only to equipment stockpiles and treatment protocols but also to identifying and trying to resolve conflicts among values. Clinicians, epidemiologists, patient advocates and ethicists had seats at the table. We’re not bound by any of the recommendations issued by the many task forces, but we’re not starting from scratch.
Bodies like these perform valuable functions, even though they do not always reach similar conclusions. They offer a chance to think critically about difficult choices before crises occur. If adopted, their recommendations and guidelines relieve caregivers of some of the burden of making the determinations themselves, allowing them to focus on how best to implement them, as their training has prepared them to do. And though none of these bodies can claim to represent the publics they serve — they’re not elected, after all — they make clear the importance of devoting time and expertise to studying and debating these questions in depth, well ahead of the need. Continue reading.