Page 30 - Delaware Medical Journal - July/August 2020

Who Gets a Ventilator in a Pandemic?
James F. Lally, MD
COVID-19 came stealthily out of China and later Europe with an uncommon ferocity that
crippled modern health care systems and upset the usual order of highly regimented economies and nation states. The pandemic has exposed glaring inefficiencies in the U.S. health care system. It also brought to the forefront questions uncommonly asked: can medical resources be allocated fairly and can our moral codes and ethical values withstand the onslaught of proposed questionable medical practices?
While the intention to save the most lives during a pandemic is noble
and morally uplifting, most health care workers would be alarmed if they had read a headline on April
1, 2020 in England’s popular Daily Mail newspaper: “Older coronavirus patients could be taken off ventilators so they can be given to younger
and healthier patients under BMA guidelines.” The article refers to
the then-released guidelines by the British Medical Association just as England was confronting a large number of COVID-19 patients that was overwhelming the scarce resources of the National Health Service. A phrase from the Eighth Amendment to the U.S. Constitution comes to mind that aptly describes such a proposal: a most
“cruel and unusual” process.
Such ethical guidelines are not unique to England, as Emanuel et al proclaim in several astounding statements: “because maximizing benefits is paramount in a pandemic, we believe that removing a patient from a ventilator or an ICU bed to provide it to others in need is also justifiable” and “reallocating ventilators from patients who are unlikely to benefit
to those who are is consistent with human rights.”1
To restate that assertion: Someone else may have a right to a ventilator that may be saving a patient’s life.
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Del Med J | July/August 2020 | Vol. 92 | No. 4