Survival of the Fittest?
A task force of representatives from medical groups, universities, the military and government agencies is basically recommending who lives and who dies after a major disaster like pandemic flu or terrorist attack.
In essence, the group recommends the very elderly, severely injured trauma patients, severely burned older patients and people with advanced dementia not receive treatment in the event of a mass-casualty situation.
The goal is to make sure resources such as ventilators, medicine -- and of course staff -- are used fairly. All the recommendations appear in an article in the May edition of Chest and are discussed on the American College of Chest Physicians Web site.
"If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing," the report stated.
The task force recommends hospitals designate triage teams who will decide which patients will and won't get lifesaving care.
Specific recommendations regarding people who should not receive care are:
- people older than 85.
- severe trauma, i.e. critical injuries from car crashes and shootings.
- severe burns in patients older than 60.
- people with severe mental impairment, i.e. advanced Alzheimer's disease.
- people with severe chronic disease, i.e. advanced heart failure, lung disease or poorly controlled diabetes.
Some argue the recommendations smack of age and disability discrimination and could create a "political and legal minefield." The American Hospital Association says the recommendations are just that, recommendations, designed to help hospitals develop their own preparedness plans even if they don't follow all the suggestions.