Foes of a "public option" frequently raise the specter of "health-care rationing" to frighten those who are nervous about government-run healthcare. The scare-mongers try to create hysteria around the idea that soulless federal bureaucrats would rather gak your grandma than pay for her dentures. (As opposed to insurance-company bureaucrats, who also don't pay for grandma's dentures but allow her to live on, toothless.)
In calmer European or Canadian contexts, "rationing" means that, if five day-long elective surgeries are scheduled for today but only four surgeons, the fifth patient has to wait until tomorrow, or whenever a surgeon becomes available. This can mean waiting for weeks or months, which is harmless enough in non-emergency situations: You still get the surgery done, and life goes on.
However, today's Times features a timely discussion about "rationing" scenarios: In the H1N1 context, who can use the limited number of ventilators and flu shots on hand? In "Worst Case: Choosing Who Survives in a Flu Epidemic," Sheri Fink relates a tough scenario that medical professionals at New York-Presbyterian Hospital had to chew on:
A 32-year-old man with cystic fibrosis is rushed to the hospital with appendicitis in the midst of a worsening pandemic caused by the H1N1 flu virus, which has mutated into a more deadly form. The man is awaiting a lung transplant and brought with him the mechanical ventilator that helps him breathe.
New York’s governor has declared a state of emergency and hospitals are following the state’s pandemic ventilator allocation plan — actual guidelines drafted in 2007 that are now being revisited. The plan aims to direct ventilators to those with the best chances of survival in a severe, 1918-like flu pandemic where tens of thousands develop life-threatening pneumonia.
Because the man’s end-stage lung disease caused by his cystic fibrosis is among a list of medical conditions associated with high mortality, the guidelines would bar the man from using a ventilator in a hospital, even though he is, unlike many with his illness, stable, in good condition, and not close to death. If the hospital admits him, the guidelines call for the machine that keeps him alive to be given to someone else.
Would doctors and nurses follow such rules? Should they?
Fink goes on to quote from several federal and state officials and plans, nicely highlighting both the policy dilemmas and human factors that will come into play if items such as ventilators ever need to be rationed in a flu-related emergency.
For a more detailed discussion of the ethics of triage, see this surprisingly lengthy and thorough Wikipedia article. It covers several nations' triage systems, including military combat and non-combat guidelines. Some triage decision-making systems are dynamic, some relatively static—but all need to be thought about or revisited now, before any hospitals fill up and people start rioting over shots of H1N1 vaccine.
Today's Post also covers the world of H1N1, including:
An odd attempt to explain why Mexico's Isla Mujeres resort area is nearly deserted. The writer blames H1N1 flu fears and the recession, not even hinting at more serious concerns about kidnapping and running gun battles in streets across Mexico until paragraph 12 (of 15).
Ongoing, obsessive coverage (here, here, here, here ...) of local H1N1 vaccination efforts, in the best local-TV-news, ten-things-in-your-medicine-cabinet-that-can-kill-you tradition.
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