Triage and Ventilators Ethics

First Discussion Post Response

I agree that age alone is not an appropriate method of triaging patients. Comorbidities, as you note, are also an important component of this. An additional observation is the fact that the use of a ventilator itself can be very taxing upon the physical system of an individual who is older, or who has significant respiratory comorbidities. Prioritization can be very difficult. But it is also important to keep in mind systemic inequalities and try not to replicate them. White & Lo (2021) note: “ICU triage policies should simultaneously promote population health outcomes and mitigate health inequities,” which means that a Save the Most Lives approach or even the Life Cycle approach is not always adequate (p.287). Individuals from historically marginalized groups may have poorer access to healthcare, and due to longstanding health inequalities, and often have a higher risk profile (such as having asthma, COPD, or a history of smoking). It is important to promote community equity in healthcare as well as to save individual lives.

Reference

White, D. B., & Lo, B. (2021). Mitigating inequities and saving lives with ICU triage during the COVID-19 pandemic. American Journal of Respiratory and Critical Care Medicine, 203(3), 287–295. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874325/?report=classic

Second Discussion Post

I agree that the Save the Most Lives versus the Life Cycle approaches are the two most commonly cited ways to deal with the difficult business of triaging patients. The first approach is a utilitarian one, focused upon expending resources upon the population most likely to benefit from the intervention, versus expending resources upon those most likely to benefit for longest (the youngest). It has even been suggested,“ Health-care providers with COVID-19 might also be prioritised on the basis of their role in treating patients affected by the pandemic” (Feinstein, et al, 2020, par. 4). A more nuanced approach is suggested by Feinstein (et al., 2020), advocating using intensive treatment, including ventilators for those patients who appear to be responding best to treatment, and more palliative options for those showing a weaker response. Regardless, these difficult ethical decisions should be discussed before crisis situations, given that during crisis situations, it can be more difficult to make intelligent healthcare decisions based upon ethics and logic.