Society of Bioethics and Medicine
WHO GETS THE VENTILATOR?
Updated: Sep 21, 2020
By - Pooja Suganthan, Edited by - Nadia Addasi May 3, 2020
At the start of the Covid-19 pandemic in New York City, news channels highlighted chaotic supermarkets crowded with shoppers. Consumers were competing to buy necessities, such as water bottles, toilet paper, and hand sanitizer in bulk. Disinfecting products and masks are now hard to find in most local stores. Similarly, hospitals are facing shortages in medical equipment and resources.
Ventilators are one of the critically needed types of medical equipment during this pandemic. Ventilators are machines that provide support to those who cannot breathe effectively on their own by pumping air in and out of the lungs through a tube that is inserted into the windpipe (Salo, 2020).
It is estimated that approximately 960,000 patients will have to use a ventilator during the coronavirus outbreak. The United States has approximately 200,000 machines. This shortage in ventilators may leave hospitals facing some tough decisions: who gets the ventilator?
There is no concrete answer to this question. Different situations call for different decisions. Dr. Matthew Wynia, the Director of the Center for Bioethics and Humanities at the University of Colorado, stated, “It would be irresponsible at this point not to get ready to make tragic decisions about who lives and who dies” (Frakt, 2020).
In Italy, doctors were told to use an utilitarian approach. This principle attempts to maximize the number of lives saved by prioritizing health care towards those who would be expected to have better outcomes. This would mean that resources would be allocated to patients based on their likelihood of survival and contributions. “Fair Allocation of Scarce Medical Resources in the Time of Covid-19,” a paper written by the Department of Medical Ethics and Health Policy at the University of Pennsylvania, suggests ethical solutions to rationing issues. These solutions carry similar utilitarian values and favor those with longer lives remaining.
Some criticize utilitarian principles. In a New York Times interview, a British researcher stated, “Is a 20-year-old really more valuable than a 50-year-old, or are 50-year-olds actually more useful for your economy, because they have experience and skills that 20-year-olds don’t have?” (Frakt, 2020). How does one compare the value of one individual over another? Some argue that younger patients deserve the chance to experience their remaining years, whereas the older patient has already led a longer life.
Some organizations, such as The Hastings Center and the Department of Health and Human Services, have developed guidelines for hospitals to reference when responding to patients. These protocols are based off of the Ontario Ministry of Health’s guidance regarding critical care during a pandemic.
Another issue is who authorizes this decision. Should it be the front-line clinician or should there be an unbiased third party? Should a person’s background and status be taken into consideration when making this decision?
Many agree that infected health care professionals should be prioritized since they are necessary to treat the increasing patients. How about members of government or essential workers who are putting their health on the line everyday? This makes us wonder if there are other ways to solve this problem without having to decide the worth of one human life over another. Is there a fast, affordable way to increase our medical resources and hospital space so that we don’t have to choose between patients?
Chotiner, I. (2020, March 11). The Medical Ethics of the Coronavirus Crisis. The New Yorker. Retrieved from https://www.newyorker.com/news/q-and-a/the-medical-ethics-of-the-coronavirus-crisis
Emanuel, E. J., Persad, G., Upshur, R., Thome, B., Parker, M., Glickman, A., … Phillips, J. P. (2020). Fair Allocation of Scarce Medical Resources in the Time of Covid-19. New England Journal of Medicine. doi: 10.1056/nejmsb2005114
Frakt, A. (2020, March 24). Who Should Be Saved First? Experts Offer Ethical Guidance. . The New York Times. Retrieved from https://www.nytimes.com/2020/03/24/upshot/coronavirus-rationing-decisions-ethicists.html?smid=em-share
Salo, J. (2020, April 1). Coronavirus: What is a ventilator and why is there a shortage? New York Post. Retrieved from https://nypost.com/2020/04/01/coronavirus-what-is-a-ventilator-and-why-is-there-a-shortage/
Weise, K., & Baker, M. (2020, March 20). ‘Chilling’ Plans: Who Gets Care as Washington State Hospitals Fill Up? The New York Times. Retrieved from https://www.nytimes.com/2020/03/20/us/coronavirus-in-seattle-washington-state.html?auth=redirect-apple