How Hospitals May Ration Lifesaving Supplies In The Event Of A Shortage
ARI SHAPIRO, HOST:
Face masks and gloves are in short supply in the fight against COVID-19. And soon, hospital beds and ventilators could be added to that list, which would force doctors to make difficult choices about which patients get lifesaving care and which don't. Dr. Lee Daugherty Biddison is one of the people working on a plan for what to do if that day arrives. She's an associate professor of medicine at the Johns Hopkins School of Medicine.
LEE DAUGHERTY BIDDISON: Thank you.
SHAPIRO: Dr. Biddison, it's good to have you here. There is a bit of a delay on the line. I understand you're working on these guidelines at your hospital. So tell us, if there is a shortage of life critical equipment like ventilators, what criteria will your doctors take into consideration deciding which patients to treat?
DAUGHERTY BIDDISON: So, at first, I'd just like to say that I think one of the most - the thing that's most important as we think about this is no one wants to be in this situation. And we're doing everything we can to avoid it. I think that's true across the country and around the world. I think if we are put in this situation, the team that we put together is really focusing on three key things. One of those is around saving the most lives. So how do you prioritize those individuals who are most likely to survive current illness? The second thing that would be considered is saving the most life years and considering how long - how much life an individual would have after the pandemic was over or after they came out of the hospital. And then a third consideration might be or would be sort of this fair innings approach, which considers life cycle and how many stages of life an individual patient has already had the opportunity to live and what might be ahead of them.
SHAPIRO: If I'm interpreting this correctly, it sounds like you're saying younger and healthier people would be treated over older and sicker people. Is that right?
DAUGHERTY BIDDISON: So I would say that what we want to do is, in this disaster situation, keep as many people alive as we possibly can. And I think that there are a number of factors that go into that, for sure. And I would say that, you know, when we think about age in particular, we had concluded that that should only be a secondary consideration and that it would only come into play if we were unable to distinguish based on the survival likelihood or survival but amongst a large group to decide who to prioritize.
SHAPIRO: You talk about saving as many lives as you can. Does that mean health care workers would get priority in hopes that they could save more lives if they are cured?
DAUGHERTY BIDDISON: So it's a great question. This sort of approach, the ethical approach, is sometimes referred to as instrumental value, and it's an approach that's been used for allocating other scarce resources like vaccines when they're in short supply with the idea that you keep someone healthy so they can continue to provide the resource or the skill set to keep more people - to take care of more people. One of the challenges with using an approach like that in this scenario is that it is - the concern would be that it'd be unlikely that someone who was ill enough to need a ventilator would get well enough in order to be able to use their skills to respond to the current pandemic...
SHAPIRO: I understand.
DAUGHERTY BIDDISON: ...And for that reason, the team that we're - yep.
SHAPIRO: Yeah. Now, I also want to ask - I know you were in Haiti 10 years ago after the earthquake there where supplies were very limited. Did you have to make these sorts of decisions there about who gets treatment and who doesn't, and does that inform your approach to the challenge in the United States today?
DAUGHERTY BIDDISON: Yeah, that's a great question. I did - I was part of a Haiti response for a brief period after that earthquake, which was a terrible situation. And I would say that it does, most importantly in that it brought home very acutely how difficult these situations are and how hard we need to work to be sure that we avoid having to make these decisions if we can.
SHAPIRO: Of course, no one wants to be faced with these decisions, but if doctors are faced with a shortage of ventilators or beds, as many are predicting, is it going to fall on the doctors in contact with patients to face those people and say, I'm sorry, but we can't help you?
DAUGHERTY BIDDISON: So it's a great question. There are a number of different ways this could work. The recommendation from our group would be that there be a separate triage team of highly skilled individuals who understands the principles and the approach but is actually separate from the front line physician making or providing the care on a day in and day out basis. The thinking was that having the same person do both would incur such a degree of moral distress that it would be unfair to the provider at the bedside.
SHAPIRO: Just briefly, is there generally consensus in the medical community about how these decisions should be made?
DAUGHERTY BIDDISON: You know, I think there I would say yes and no. There are certainly several different approaches, but I know that from our experience, one of the things that we really worked hard on is to gather a consensus in - both within our health system, within health systems within our region and in neighboring states so that there is a consistent approach in the region. Yep.
SHAPIRO: Thank you so much. Dr. Lee Daugherty Biddison, associate professor of medicine at the Johns Hopkins School of Medicine, we appreciate your time and the work that you're doing.
DAUGHERTY BIDDISON: Great. Thank you so much.
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