“We use a scoring system that predicts the likelihood of survival,” said Dr. Hassan Khouli, chief of the critical care section and chair of the ethics committee at Mount Sinai Roosevelt in New York City. Khouli serves on the state’s task force that is updating the guideline to include children. “The ethical principle driving this is to save the most lives.”
Recently the Boston Globe noted: “New York is one of only a handful of states that has a guideline recommending how hospitals should allocate ventilators should a deadly flu pandemic strike this country, similar to the one in 1918 that killed 675,000 Americans.
As the death toll from Ebola nears 900 in West Africa, medical ethicists warn that US medical facilities and states have few plans in place to allocate limited supplies of life-saving medications and equipment such as ventilators if such a deadly outbreak were to occur here.
Public health officials say it is unlikely the disease would spread widely in the United States because infection control procedures and protective gear are more advanced than in Africa. But the unprecedented number of cases in Africa and the ease of travel have ethicists and emergency preparedness experts pondering what-if scenarios.
With no vaccine or drugs to fend off Ebola, they say, an outbreak could overwhelm hospitals as patients compete for supplies of ventilators to help them breathe or beds in intensive care units. If an experimental vaccine becomes available, its supply would be limited at first — as were supplies of vaccine during the outbreak of the H1N1 ‘swine’ flu in 2009 — and determining who would be the first to get it in a national epidemic could cause widespread panic.
Only a few state health departments have established ethical guidelines for rationing medical care in certain situations. Massachusetts is not one of them, offering no guidance for how hospitals should distribute immunizations or treatments in short supply, according to the Department of Public Health.
“Imagine we have a pandemic in Boston with proven treatments that are in limited supply,” said Dr. Robert Truog, director of Harvard Medical School’s Center for Bioethics. “We have not adequately thought through how to make the allocation decision of who will get it and who will not.”
“The CDC and Institute of Medicine have recommended ways to allocate scarce vaccines and ventilators, but these are voluntary. The CDC recommended, for example, that vaccines and anti-viral medications should first be distributed during a flu epidemic to those who preserve the “functioning of society” — vaccine makers, police officers, and hospital workers — over those who are more likely to experience serious complications, such as pregnant women.”
Click here to read the full Boston Globe article “Few preparations in event of Ebola in US” by by Deborah Kotz.
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Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration.
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