Worst Case: Choosing Who Survives in a Flu Epidemic

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New York state health officials recently laid out this wrenching scenario for a small group of medical professionals from New York-Presbyterian Hospital:

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?

http://www.nytimes.com/2009/10/25/weekinreview/25fink.html

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This is not about a real person. It is just a scarey example.

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Specializes in Ante-Intra-Postpartum, Post Gyne.
This is not about a real person. It is just a scarey example.

Reminds me of Y2K...had a friend who's crazy parents practically had a grocery store in their house because of all the scary hype.

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Specializes in cardiac, ortho, med surg, oncology.
This is not about a real person. It is just a scarey example.

The article makes it rather obvious that this is not a real person or even or real scenario merely a hypothetical one. It is discussing an unlikely but remotely possible situation and discussing the ethics and legality of it. All I can say in response to the given scenario is that I would rather quit than be placed in a position to play God and decide who gets what limited resources.

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It sounds as if the vent this young man is on happens to be his own property, though I am not sure of it. I don't think you could take a persons private property. Much more likely is the situation I put forth on another thread. Two children come in with sever respiratory distress to ER. The pandemic is at it's highest point. Resources are strained to the limit. One child is the child of a self employed plumber with no health insurance and the other is the Govenor's(not talking about any particular Govenor) grandchild. Who do you think is going to get priority treatment?

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Much more likely is the situation I put forth on another thread. Two children come in with sever respiratory distress to ER. The pandemic is at it's highest point. Resources are strained to the limit. One child is the child of a self employed plumber with no health insurance and the other is the Govenor's(not talking about any particular Govenor) grandchild. Who do you think is going to get priority treatment?

Can you direct me to the thread? I think I can predict the ending, but would like to hear the rationale for the choice. I think the decision would have to be handled with secrecy whichever way it goes. It's an interesting (and likely) scenario.

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Specializes in Too many to list.

Dr. Nancy video on rationing of ventilators. I don't know how long this will be available. Video links don't usually stay up very long.

http://www.msnbc.msn.com/id/31388323/vp/33860038#33860038

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Specializes in Dialysis, Nephrology & Cosmetic Surgery.
Dr. Nancy video on rationing of ventilators. I don't know how long this will be available. Video links don't usually stay up very long.

http://www.msnbc.msn.com/id/31388323/vp/33860038#33860038

Very interesting that it mentions people taking some responsibility to protect themselves and in particular not refusing the vaccine if they have been offerred it. If they have refused to be vaccinated when offerred the chance to do so, they may well find themselves triaged unfavourably. It would be interesting to throw this into the heated discussion going on in the forum on compulsory swine flu vaccination. It seems a lot of nurses are refusing this and I wonder how they feel about the possibility of them being refused the option of ventilatory support in favour of someone who was not been fortunate enough to have the vaccine?

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