U.S. Hospitals Prepare Guidelines For Who Gets Care Amid Coronavirus Surge Doctors in Italy are overwhelmed by coronavirus cases and prioritizing which patients get care. Many U.S. doctors could soon be making the same life-or-death decisions.
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U.S. Hospitals Prepare Guidelines For Who Gets Care Amid Coronavirus Surge

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U.S. Hospitals Prepare Guidelines For Who Gets Care Amid Coronavirus Surge

U.S. Hospitals Prepare Guidelines For Who Gets Care Amid Coronavirus Surge

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MICHEL MARTIN, HOST:

In Italy, some hospitals are so inundated with coronavirus cases that doctors are being forced to make difficult choices about which patients get lifesaving care. Some health care experts warn that U.S. doctors could soon be making similar life-or-death decisions. Sacha Pfeiffer of NPR's investigative team is with us to explain how in times of triage hospitals decide who gets treatment and who does not.

Sacha, thanks so much for joining us.

SACHA PFEIFFER, BYLINE: Thanks for having me.

MARTIN: So if the U.S. eventually does face a situation like that occurring in Italy, how are we going to handle it?

PFEIFFER: So every accredited hospital in the U.S. is required to have some mechanism for addressing ethical issues like this. What hospitals usually have is an ethics committee made up of not just health care professionals but also maybe a social worker, a pastor, a patient advocate. Some hospitals also have triage committees. And together, they create guidelines for prioritizing patient care if there's a resource shortage. And those guidelines vary from hospital to hospital.

MARTIN: Do they all share the same basic principles?

PFEIFFER: Basically, yes. The overall goal is usually to save the most lives. So hospitals consider a combination of factors. There's age, life expectancy, how severe your illness is, how likely treatment is to help you, whether you have additional illnesses that could shorten your lifespan like cancer or heart disease. And then they use those factors to develop scoring systems, or clinical scores, to prioritize care.

And just this month, Italy issued guidelines saying doctors may have to prioritize younger coronavirus patients over older patients. But age is rarely the only factor. So a 20-year-old is not always going to get priority over a 60-year-old, especially if that 20-year-old has other health problems that could mean the 60-year-old is likely to live longer anyway.

And, Michel, here's another ethical challenge raised by Nancy Berlinger of The Hastings Center. It's a nonprofit bioethics think tank. Berlinger says, imagine a patient who is on a ventilator but is not improving.

(SOUNDBITE OF ARCHIVED RECORDING)

NANCY BERLINGER: And this patient might - might - do better if they were allowed to stay on the ventilator longer. But there are people waiting for that ventilator. Do you withdraw the ventilation earlier than you might normally do? So it's not just, who gets the vent? It's also who stays on it.

PFEIFFER: Another factor in who gets to stay on that ventilator could be social usefulness. For example, should a hospital give priority to a sick nurse because that nurse could go on to save other lives?

MARTIN: And who determines that? I mean, are other professions factored in? For example, you know, would a hospital prioritize a hedge fund manager or perhaps a big donor over a convenience store clerk?

PFEIFFER: Most guidelines say that every life has equal worth, so you should be evaluated the same way whether you're employed or unemployed, no matter what you do for work, male or female, black or white, childless or the parent of several kids. Now, ideally, hospital decision-makers should have blinded information that blocks them from even knowing those details. And they should only consider clinically relevant factors.

MARTIN: But would those guidelines even work in a crisis situation where hospitals may not have much clinical information or who may be inundated?

PFEIFFER: I wondered that same thing. And basically, what the doctors told me are these are best-laid plans, and we don't have an exact historical comparison in terms of illnesses for how this could play out. But they at least provide some guidance.

MARTIN: Do we have a sense, Sacha, of how likely these guidelines are to be needed in this current environment?

PFEIFFER: I asked several doctors that, too. And one of them was Dr. Matthew Wynia. He's director of the University of Colorado Center for Bioethics and Humanities, and here's how he answered that.

MATTHEW WYNIA: This is a worst-case scenario that we're talking about. We hope we never get there, but we have to get ready for the worst. And it would be irresponsible not to be getting ready right now because of what we're seeing in other places around the world, where things really have gone very, very badly and where they have run out of equipment, supplies, staff, space, people. So we need to be prepared for that.

PFEIFFER: And Dr. Wynia says by being prepared and by all of us doing the social distancing we've been asked to do, hospitals hope never to have to implement these kinds of triage strategies.

MARTIN: That is Sacha Pfeiffer of NPR's investigative team.

Sacha, thank you.

PFEIFFER: You're welcome.

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