The Corner

Health Care

Doctors and Professors Offer Moral and Ethical Guidance for Coronavirus Health Care

U.S. Army Major Sean Shirley holds a meeting with staff in the Javits New York Medical Station intensive care unit bay monitoring coronavirus patients in New York City, April 4, 2020. (Chief Mass Communication Specialist Barry Riley/U.S. Navy, Handout via Reuters)

As Ramesh noted in a Corner post earlier today, the journal of the Witherspoon Institute at Princeton University has published a helpful joint statement from several professors and medical doctors on providing ethical care during an overwhelming medical crisis such as the one we’re facing at the moment.

I had a post a couple of weeks ago on how some government officials in parts of the U.S. have begun advising hospitals on the proper ways to ration care in the event of shortages. As I mentioned in that post, in a health-care crisis, some degree of health-care rationing will be unavoidable. But some of the guidelines in question have set parameters such as allocating resources to patients based on criteria like “loss of . . . physical ability, cognition and general health.” In short, state departments of health were making “quality of life” assessments that would tend toward age or disability discrimination, if put in practice.

The joint statement from the Witherspoon Institute is aimed at addressing these sorts of arguments over proper ethics in triage and crisis medical care. The signatories — including Princeton professor Robert P. George, Fordham professor Charles Camosy, and Johns Hopkins professor and medical doctor Paul McHugh — elaborate on principles such as “allowed casualties are not intentional killings” and “human lives are all of equal value.”

“We need to exercise tremendous caution in our language: ‘choosing who will live and who will die’ is a dangerous way of expressing what we are about in trying to save whom we can, while mourning the loss of those we are unable to save” they write.

Another key point they make is that choices to prioritize treatment for some over others must not lead to a belief that the lives of those who are prioritized are of greater value:

It is a constant temptation of humanity to elevate the lives of some over the lives of others, and this will surely be augmented by the practice of prioritization. But it should be clear that while there are valid reasons (in certain circumstances) to give priority to, for example, health care workers, this hardly means that their lives are more valuable or more important than the lives of their patients. We must be vigilant to ensure that the coronavirus crisis does not lead to any cheapening of the value and dignity of each individual human being’s life.

The letter also discusses the emphasis that some proposed guidelines have placed on “life-years” (or, more colloquially, age) when determining how to allocate care. The signatories argue that such an approach would logically lead to an embrace of a discriminatory standard of care that marginalizes the elderly:

We all share a concern that a life-years approach, even if used only as a secondary consideration, could come to be understood in ways that would cut against the claims of the elderly, the disabled, and those who seem to have little to contribute.

Simply put, we fear the practical effects of emphasizing life-years, especially in a culture like ours. In practice such a policy could appear to systematically privilege the lives of the young over the old. Day after day, week after week, all across the country, and with the whole nation watching, the pattern would recur: a ventilator would be denied to an older patient and given to a younger one; denied to the 50-year-old in favor of the 30-year-old or the 15-year-old; taken from the middle-aged or retired, from parents and grandparents.

The letter concludes by insisting that, as doctors determine the best ways to handle health-care shortages during the coronavirus outbreak, “we must not blur the distinction between ‘saving the most individual lives’ and ‘saving the most life-years.’” It’s a helpful distinction — and a helpful letter — not only for the current crisis but also for our broader debates and discussions about ethical health care.

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