‘Nobody Wants To Make These Decisions’: Who Gets A Ventilator In The Coronavirus Pandemic?

SOUTH HILLS (KDKA) — When there aren’t enough breathing machines to go around, how do hospitals decide who gets them?


“Nobody wants to make these decisions. Nobody wants to be in a position of making these decisions,” says Carnegie Mellon University medical ethicist Alex John London.


Hospitals will have to consider a number of ways to ethically provide for patients with what they have.


For instance, should it be first come, first served? This takes some of the subjectivity out of it.


(Photo Credit: KDKA)


“If the resource is available when people show up, they get it,” London said.


But it puts latecomers at a disadvantage.


How about giving them to the sickest? Or to those most likely to survive? Or to those with the most years left?


“If you pour resources into someone who isn’t going to survive, then the worry is you may have allowed several other people to perish who might have been helped.”


Should health care workers get them, so they can help more patients?


“We really need them on the front line helping as many people as possible,” London said.


There are relative merits and deficiencies with all of these criteria.


“There’s room for legitimate disagreement. There is widespread agreement that we want to treat everyone equally, as far as that’s possible,” London said.


Decision making should not be up to the clinicians but determined by the health systems.


“It’s a difficult process, but it’s one that is best undertaken prior to this sort of outbreak. Health systems that plan and are prepared will be in a better position than those who didn’t,” London said.


Other issues — how long to keep someone on a ventilator while other patients are waiting?


If somebody’s heart stops, do you go ahead with aggressive measures that could expose health care workers to infection?


While we haven’t hit the surge in our area yet, these are just some of the dilemmas hospital ethics committees will have to grapple with.