We're From The Government & We're Here To Help You

This is not a good time for hospital emergency room or intensive care unit director physicians in your communities. If a more severe mutated form of H1N1 ("swine") influenza or a more lethal influenza such as H5N1 (avian) appears, one of these physicians may have to make decisions for which he or she is not likely to be professionally prepared, for which there are  no community accepted ethical standards, and which may leave the decider professionally liable for misconduct and exposed to personal financial ruin.

Quietly and without significant current public input or current public ethical discussion , national, state and local public health authorities have assumed the responsibility to order the take-over of public, private and non-profit hospitals, and determining the priorities to be applied when providing life-saving treatments during a national health emergency which swamps the system. As described in The New York Times, 10/25/2009 "Week in Review" section at page 3, the dilemma of "Choosing Who Gets the Breath of Life" and other serious issues of life-saving facility availability will be resolved by government-prescribed triage rules, rather than the rules which govern today's allocation of health care.  Who among this blog's readers knows what those triage rules are? Who gave appointed officials the authority to dictate this approach to medical decision-making?

Who among my readers knows which patients will be allowed to continue to receive respirator support and which patients will have that support terminated for the benefit of another person? Who among my readers knows which patients will have dialysis terminated so that another person can have access to the dialysis machine? Who among my readers knows whether, under the triage rules, some older citizens will be removed from life-saving support to benefit those who are younger, what the rules will be on allocation of support among various races, ethnicities, religions, social groups, economic status groups, political members, citizenship groups or occupational groups?

Decisions will have to be made. But having them made by appointed bureaucrats without vigorous current public input  and without active current discussion of the ethical issues is inappropriate.  The public has the right to participate in this discussion and those with experience and expertise in analyzing and formulating ethical choices and decisions should be heard.

After all, this is America.