The Influenza Pandemic Has Arrived But There Are Not Enough Ventilator Machines!
The news of the outbreak of flu at first came in little spurts from various communities across the United States. And there was bad news with each bulletin; patients were dying from the flu… a whole lot of the patients who were sick. The government labs then came out with the news that the sickness was due to a particularly virulent strain of influenza virus. We had all known that this might happen and now everyday came the news that the sickness had spread across the country to little towns and big cities and the influenza sickness was everywhere. The patients, many of whom were previously healthy, were developing pneumonia and becoming short of breath and would quickly die if they were not put on the ventilator to allow them to breathe. Even then, many died because of other organs that failed including the heart. More sickness and more deaths and there was no dramatic medication avilable to abruptly cure the illness. But it became obvious that some patients supported by the ventilator machine could be kept alive long enough for their own body defense mechanisms and other supportive treatments would allow them to survive the illness.
Unfortunately, by now, so many patients were sick, couldn’t breathe and had to be put on a ventilator but there were far too many patients who needed the ventilator than the number of ventilators available. How and to whom should the ventilators be allocated?
This is only one of the issues that will appear when a serious influenza pandemic strikes our country or other countries throughout the world. It is wise, therefore, to be proactive and plan ahead for the day when the deadly flu arrives. Planning, of course should be done by the appropriate governmental agencies but also there are reasons why these plans should be devised by input from the public. That is because, decision about how to set up the triage of patients involves issues which are less medical or clinical but are actually societal.
If patients are found clinically to need the ventilator to survive, to whom should the ventilator be given? Only to the young? Would there be a cut off age? Only to the previously healthy and how healthy? Should leaders of elected government be given priority? Should those in prison be ignored? Should the poor be given first chance at a machine? Should sick healthcare workers and emergency first responders who are most needed to care for others and are at greater risk be given first chance at a ventilator? Who are the ones most needed? Are they the doctors? the nurses? the respiratory therapists who operate the ventilators or who else and in what order? If someone is on the ventilator, at what point should the patient be taken off and another patient allowed to use the machine? Patients who had chronic lung problems and were already on a ventilator at the time of the epidemic, should they be allowed to continue use or should they be taken off and the machine used for an acutely ill flu patient? All of these questions and more need the public input. As I already noted, the issue involving the limited number of ventilators available is only one concern in a pandemic. Others would include isolation of the infected, where patients should be treated if all hospital beds are taken and many issues of the management of education, business, economy, government including other issues of public safety.
It is not too early to start a discussion by the public on these questions. For the present, on this blog, let’s discuss the ethical allocation of ventilator machines. ..Maurice.