Under unprecedented circumstance, and in the absence of federal guidance, hospitals have formed triage committees to guide life-and-death decisions
From ambulances to intensive care units, the Covid-19 pandemic has forced American healthcare workers to make gut-wrenching decisions about a patients fate once rare even for hospital ethics committees.
Those decisions are now made under a new paradigm scarcity.
Were just not used to this in the United States, where we feel like resources are always available, said Mildred Z Solomon, the president of the New York-based Hastings Center, one of the worlds leading bioethics thinktanks. Its a tragedy.
Physicians in America now practice in an exceedingly rare time of shortages many and varied, one ethicist said. The most pressing national concern is lack of ventilators. Medical device analysts predict another 75,000 will be needed across the United States to care for the roughly 10% of Covid-19 patients who need them.
But thats not where it ends. Ventilators are the ones that everyone hears about, but there are so many shortages, said Dr J Wesley Boyd, an associate professor of psychiatry at Harvard medical schools center for bioethics.
Dialysis machines are in high demand as Covid-19 patients go into kidney failure. Doctors are low on supplies of painkillers and sedatives needed for ventilator patients, who have a deeply uncomfortable tube inserted into their mouth and windpipe. And hospitals are already rationing protective equipment and testing swabs.
To deal with the unprecedented circumstance, and in the absence of federal guidance, hospitals have formed triage committees to guide life-and-death decisions. While there were instructions on how to categorize patients and allocate critical resources before Covid-19, many of these documents are no longer relevant. New Yorks last state guidelines on ventilator allocations are from 2015.
Now, hospital leadership is appointing new interdisciplinary teams, adapting emergency room triage, and coding patients by their likelihood to survive.
Triage will save lives, Solomon said. And unpleasant as it is to estimate survivability, we could end up using this equipment on people who are going to die anyway, and not offering it to people who could have been saved.
At the University of Pittsburgh school of medicine, decisions will be made by a team of one critical care specialist, an acute care nurse and an administrator. Patients own doctors will not make triage decisions and triage will not bar any patients such as those with a pre-existing lung condition or disabilities. However, the hospital system will prioritize healthcare workers, in hopes those workers will eventually save more lives.