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Don’t make the doctor decide who lives and who dies

Doctors grapple with ethics in COVID-19 care around ventilator shortage and CPR

Health care providers are grappling with painful ethical dilemmas and a radical shift in patient protocols as COVID-19 cases begin to spike around the country.

Dr. Kelly Michelson, director of the Center for Bioethics and Medical Humanities at Northwestern University Feinberg School of Medicine, said deciding how to allocate ventilators and when not to do cardiopulmonary resuscitation are among the toughest ethical decisions facing health care providers now.

She is available to discuss ethics in the time of COVID-19. Contact Marla Paul at marla-paul@northwestern.edu to talk to Dr. Michelson.

Some quotes from Dr. Michelson, who also is a professor of bioethics and medical humanities and of pediatrics at Northwestern and a physician at Ann and Robert H. Lurie Children’s Hospital of Chicago.

Don’t make the doctor choose who lives and who dies

“If there are not enough ventilators for everyone who needs them, we need a process that takes the decision away from the doctor who is caring for an individual patient or group of patients. Most institutions are developing a plan in which a team of people who are not taking care of the patients use data to make these decisions with as much objectivity as possible and using ethical principles as a guide. As a doctor, I have an obligation to do whatever I can to take care of my patient. But during a crisis, like COVID-19, health care organizations like hospitals have to think not only of the life of individuals but also of the community.”

Goal is saving as many lives as possible 

“We should start with the principle that every life is worth saving and balance that with the goal of saving as many lives as possible. The first strategy is to identify those people most likely to benefit from ventilation. Some patients are so sick that they are unlikely to survive even if they are put on a breathing machine. There are compelling reasons to use ventilators for those patients who are likely to get better.” 

“After that, it’s more complicated. Some support the goal of saving as many life-years as possible or stages of life. If you have two people who have exactly the same medical condition, but one is older than the other, by saving the younger person you are hoping to maximize the number of life-years saved. Also, many argue that people essential to society should be prioritized—essential people might include health care providers or other people in the community essential to maintaining the stability of our everyday lives. If health care workers are not available to save lives, fewer lives will be saved.

"Another consideration is whether pregnant persons should be prioritized. By saving a pregnant person with a viable fetus, you are saving two lives.”