Recently released guidelines suggesting less frequent screening for breast and cervical cancer caused quite a commotion over the last week, prompting some critics to warn of government rationing. Compared with those reports, a guidance proposing an ethical "framework" for rationing scarce ventilators in the event of a severe influenza pandemic arrived yesterday in relative silence.
Short supplies of ventilators could force tough decisions, if swine flu gets ugly.
We predicted a move like this back in September. ProPublica, a nonprofit investigative newsroom, obtained a copy of the guidance and posted it Monday, hours before a public Centers for Disease Control and Prevention teleconference on the document. The CDC advisers who drafted the guidance voted to approve it during the call, but said it wouldn't apply to the current swine flu pandemic unless it becomes significantly more severe, ProPublica reports.
The guidance — for use only when demand for life-saving ventilators far exceeds supply — says the equipment "will need to be allocated according to different guidelines than during usual clinical care." Rather than using ventilators to treat the sickest patients, the CDC advisers suggest using criteria such as the likelihood that a patient will survive, the number of years the patient is expected to live, and age.
The ventilator plan could become "another potential distraction" for the White House, Politico writes. Administration officials already distanced themselves from the breast cancer screening recommendations after they were attacked.
Though the ventilator report avoids the hot-button word "rationing," it shifts at one point to a battlefield metaphor to get its point across: "When treating soldiers with life threatening injuries, medics give priority to those who are most likely to survive with a relatively small amount of scarce resources."
As ProPublica's Dr. Sheri Fink points out, the document is not binding, and is meant to guide local public health officials as they plan for likely ethical dilemmas. The same is true of the mammogram and Pap smear guidelines. Fink also notes that the panel began work on the guidance two years ago, a fact that could provide some cover for the White House if controversy ensues.
An early taste of the potential outcry came during the CDC conference call yesterday: One caller, a member of the public who identified herself as Marcia Baker, called the panel's efforts "Hitlerian," Politico reports. Instead of "rationing" care or choosing who "isn't worthy to live," the government should "build for the peak of a severe pandemic," she said.
One panelist said he resented that assertion. Another asked whether Baker would "want to pay the taxes" necessary to stockpile an untold number of ventilators that may never be used.
Weaver is a reporter for Kaiser Health News, a nonprofit news service.