When I enter an airplane I know that if there is a crash my chance of survival, already slim to begin with, are virtually nil because of my inability to walk. In the event of a disastrous crash I am under no illusion that any of my fellow passengers or airline personnel are going to help me get out of a plane. While I have no trouble accepting this reality, I was disturbed to read an AP report about a group of doctors who are trying to determine who should be saved in the event of a pandemic flu or other large scale disaster. In 2007 a task force was created to address this issue. Among those agencies involved were the Department of Homeland Security, the Centers for Disease Control and Prevention, and the Department of Health and Human Services.
The people involved had an unenviable job--make God like decisions about who will live and who will die. Among those selected to die include the following:
People over 85.
People with severe trauma such as victims of shootings or car accidents.
People older than 60 who are burn patients.
People with sever mental impairments such as Alzheimers.
People with sever chronic illnesses sucha s heart disease or diabetes.
My first thought when I read the AP report, "Who Should MDs let Die in a Pandemic" was singularly selfish--I was relieved to know I was not at the top of the list thereby assured that my life had value. This article led me to read the Summary of Suggestions From the Task Force for Mass Critical Care Summit held in January of 2007. Now, this summary was truly scary (http://www.chestjournal.org/cgi/content/full/133/5_suppl/1S). Part of me thinks that such a document is necessary. Afterall someone has to think about dooms day scenarios. But this thought was quickly replaced by the knowledge that disasters do indeed happen on a regular basis. As Hurricane Katrina taught us the people most likely to suffer are not necessarily the sickest members of society but rather the poor and disenfranchised. I understand that doctors are often faced with unenviable ethical dilemmas and are forced to play God. But I wonder how much attention those that attended this summit meeting gave to the poorest members of our society that are routinely denied adequate medical care. Study after study has shown that a disproportionate number of poor people suffer from chronic illnesses listed above and that disabled people often live at or below the poverty line. If a disaster occurs the poor and disabled are among the most likely to die. The reasons for this are as much social as they are medical.
The efforts made to determine who to save in the event of a disaster are a grim reminder that humans are forever vulnerable to disease and the power of nature. Yet the document produced is not a straight forward blueprint about how hospitals and institutions should react than it is a referendum about the value we place on the lives of others. To me, the recommendations are a political minefield that speaks volumes about members of our society who are either too poor or physically unable to care themselves. Surely the people in question who attended this summit meeting can do better or at least try to determine a way to save all humans--those rich and poor, disabled and not disabled.
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