CHICAGO, May 5, 2008

Who Should Doctors Let Die In A Pandemic?

Report: The Very Elderly, Seriously Hurt Trauma Victims Among Those Who Wouldn't Be Treated

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(AP)  Doctors know some patients needing lifesaving care won't get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let die.

Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn't be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

The proposed guidelines are designed to be a blueprint for hospitals "so that everybody will be thinking in the same way" when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical care specialist in San Diego and lead writer of the task force report.

The idea is to try to make sure that scarce resources - including ventilators, medicine and doctors and nurses - are used in a uniform, objective way, task force members said.

Their recommendations appear in a report appearing Monday in the May edition of Chest, the medical journal of the American College of Chest Physicians.

"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 states.

To prepare, hospitals should designate a triage team with the Godlike task of deciding who will and who won't get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:

  • People older than 85.

  • Those with severe trauma, which could include critical injuries from car crashes and shootings.

  • Severely burned patients older than 60.

  • Those with severe mental impairment, which could include advanced Alzheimer's disease.

  • Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

    Dr. Kevin Yeskey, director of the preparedness and emergency operations office at the Department of Health and Human Services, was on the task force. He said the report would be among many the agency reviews as part of preparedness efforts.

    Public health law expert Lawrence Gostin of Georgetown University called the report an important initiative but also "a political minefield and a legal minefield."

    Fast Fact

    If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability.

    The recommendations would probably violate federal laws against age discrimination and disability discrimination, said Gostin, who was not on the task force.

    If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said. While health care rationing will be necessary in a mass disaster, "there are some real ethical concerns here."

    James Bentley, a senior vice president at American Hospital Association, said the report will give guidance to hospitals in shaping their own preparedness plans even if they don't follow all the suggestions.

    He said the proposals resemble a battlefield approach in which limited health care resources are reserved for those most likely to survive.

    Bentley said it's not the first time this type of approach has been recommended for a catastrophic pandemic, but that "this is the most detailed one I have seen from a professional group."

    While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary, Bentley said.

    Devereaux said compiling the list "was emotionally difficult for everyone."

    That's partly because members believe it's just a matter of time before such a health care disaster hits, she said.

    "You never know," Devereaux said. "SARS took a lot of folks by surprise. We didn't even know it existed."




    © MMVIII The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.

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    Add a Comment See all 163 Comments
    by briannorwood May 5, 2008 9:21 AM PDT
    Who should doctors let die in a pandemic?

    That''s easy... Sean Hannity, Rush Limbaugh, Bill O''Reilley and Anne Coulter would be a great start!
    Reply to this comment
    by rational_1 May 5, 2008 9:33 AM PDT
    Nothing really new or surprising here - triage has been going on for a long time. It may seem heartless, especially coming from physicians, but it''s necessary. Let''s hope they don''t ever have to put these plans into effect.
    Reply to this comment
    by godseyesore-2009 May 5, 2008 9:33 AM PDT
    This regime is antithetical to Hippocratic oath, and in line with Nazi methodologies (which we have been and are being subjected to). I wonder if "Doctors" are exempt from the list of those left to die?
    Reply to this comment
    by oldone60 May 5, 2008 9:38 AM PDT
    Nope - you got it wrong. The list should include Huffington and anyone associated with MoveOn.org. That is, hard left jerks who don''t contribute to the society. Note that I can''t think of any really influential talk radio hosts on the left - there aren''t any!

    BTW, I consider the Pandemic Planning List as a test balloon for how health care will be rationed if Clinton or Obama get their way.
    Reply to this comment
    by rational_1 May 5, 2008 9:45 AM PDT
    This regime is antithetical to Hippocratic oath, and in line with Nazi methodologies (which we have been and are being subjected to). I wonder if "Doctors" are exempt from the list of those left to die?
    Posted by godseyesore at 09:33 AM : May 05, 2008

    The reason for doing this is that with limited resources and limited time to spend on each patient, doctors are forced to make choices. Sure they can spend considerable time, effort and resources to keep an Alzheimers patient alive, and they may well succeed, but what about the 10 other people they didn''t have a chance to get to because of all the effort expended on one person? You okay with them dying just because the Alzheimers patient happened to be wheeled in first? I sure hope doctors are exempt - we need them alive to minimize the odds of the rest of us dying.
    Reply to this comment
    by berniepeders May 5, 2008 9:45 AM PDT
    I''d wager that NO MDs are on their list. "Too valuable", right? Bunch of hypocrites!
    Reply to this comment
    by berniepeders May 5, 2008 9:47 AM PDT
    rational1- Would you feel the same if YOU were the one with Alzheimers (or one of your loved ones)? When the shoe is on the other foot, sometimes our opinions change, don''t they?
    Peace.
    Reply to this comment
    by sgtrds May 5, 2008 9:47 AM PDT
    Republicans.
    Reply to this comment
    by walt1944-2009 May 5, 2008 9:55 AM PDT
    This reminds me of the "guidelines" the Nazis used in Germany concerning the mentally ill.

    Their rationale was simple: if you didn''t think or act like a "normal" human being, you were killed. No mental hospitals, no medicines, no extra expense to the state to take care of you; just a shot in the arm and a hole in the ground!

    This is what our country has come to! Another Nazi state!

    SIG HEIL, BUSH!!!!
    sig heil, more of the same, McCain!!!
    Reply to this comment
    by hawksprings May 5, 2008 10:05 AM PDT
    Who should doctors let die in a pandemic?

    1. Liberal Politicians.
    2. Liberal Professors.
    3. Trial Lawyers.

    Not necessarily in that order.
    Reply to this comment
    by extremophil May 5, 2008 10:15 AM PDT
    Who Should Doctors Let Die In A Pandemic?

    Tough question, but don''t pick me.
    Reply to this comment
    by justfacts2 May 5, 2008 10:23 AM PDT
    I guess the doctors on the report didn''t know of the HYPPOCRATIC OATH one takes before becoming a doctor. This list is just another way for hospitals to discriminate against patients, and ANY hospital that follows these so-called guidelines deserve to get sued.
    Reply to this comment
    by nonayabiness May 5, 2008 10:23 AM PDT
    Congress
    Oil Company Executives
    Mortgage Company Executives
    Credit Card Company Executives
    President Bush

    -Not necessarily in that order
    Reply to this comment
    by rational_1 May 5, 2008 10:24 AM PDT
    rational1- Would you feel the same if YOU were the one with Alzheimers (or one of your loved ones)? When the shoe is on the other foot, sometimes our opinions change, don''''t they?
    Peace.
    Posted by berniepeders at 09:47 AM : May 05, 2008

    I certainly wouldn''t be happy about it and I''m not even viewing this in a happy light now. I just know that sometimes hard choices have to be made and there''s no point in burying your head in the sand and pretending the problem isn''t there. Unlike me and you who would be swayed by emotions because this would involve our relatives, the doctors who don''t know any of us would (and should) view things more dispassionately. Let me turn things around and ask you what you would do if you were in the shoes of the physicians. You have limited resources, time and manpower - and the sick are coming in. Your underlings look to you for orders. What will those orders be?
    Reply to this comment
    by toolmangler-2009 May 5, 2008 10:24 AM PDT
    Doctors and Nurses have no business playing GOD, take them as they come, don''t pick and choose. Treat them all, let GOD sort it out.
    Reply to this comment
    by zorar-2009 May 5, 2008 10:25 AM PDT
    Bush, Chaney & the blind republican christian right..
    this is a no brainer
    Reply to this comment
    by oscarez May 5, 2008 10:26 AM PDT
    All Republicans over the age of 65. This should solve the problem with Social Security.
    Reply to this comment
    by oldone60 May 5, 2008 10:31 AM PDT
    Who should doctors let die in a pandemic?

    Lieberal Democr@p
    Reply to this comment
    by libh8er May 5, 2008 10:34 AM PDT
    ''Who Should Doctors Let Die In A Pandemic?''

    Start with liberal democrats and then work backwards from there!
    Reply to this comment
    by nonayabiness May 5, 2008 10:39 AM PDT
    Actually, seriously, I can agree some guidelines should be in place about how to provide the most effective care if a serious and sudden nationwide pandemic occured. It''s about quality of life and chance of survival.
    Reply to this comment
    by nonayabiness May 5, 2008 10:43 AM PDT
    This is no different than, in war, there are times when medical personnel have to choose who they can help and who they cannot with the limited resources they have. I don''t recall anyone ever accusing them of playing God. Let''s just all hope nothing ever comes of this.
    Reply to this comment
    by dwath1 May 5, 2008 10:49 AM PDT
    1. The smallness of the minds who respond never ceases to amaze me. President Bush, Oil Co executives etc etc.
    2. This IS a serious issue. It is also a good first step towards the real necessary discussion if the government is going to take over the personal responsibility of Health Care. These are EXACTLY the questions that need to be be asked before you craft a program. So many are screaming the Government has to institute a program now. BUT NO ONE is talking about what the coverage should be. First question is How much do you owe me to keep me alive? Indefinately drooling in my bed on life support? Terminal but go ahead and spend 500k on a liver transplant? Lifelong Alchoholic who has destroyed his liver, still is drinking and wants a new liver? Old? Young? Folks. This is a very serious subject and the discussion is not only valid, but also long overdue.
    Reply to this comment
    by toolmangler-2009 May 5, 2008 10:54 AM PDT
    I don''''t recall anyone ever accusing them of playing God. Let''''s just all hope nothing ever comes of this.
    Posted by NonayaBiness at 10:43 AM : May 05, 2008



    I am not accusing them of playing GOD, but this policy making is one more step in the path to Euthanasia. look closer and see the footprints leading to the future.
    Reply to this comment
    by erasmus81 May 5, 2008 10:56 AM PDT
    "Let''''s hope they don''''t ever have to put these plans into effect." Posted by rational_1 at 09:33 AM : May 05, 2008

    It is just a matter of time before we have a pandemic. I don''t trust these other countries to control the bird flu, ebola, etc. When it hits, we are in big trouble.
    Reply to this comment
    by erasmus81 May 5, 2008 10:58 AM PDT
    Who should doctors let die in a pandemic?

    1. Liberal Politicians.
    2. Liberal Professors.
    3. Trial Lawyers.

    Not necessarily in that order.

    Posted by HawkSprings at 10:05 AM : May 05, 2008


    #4 Global warming non-believers.:)
    Reply to this comment
    by marcpcbs May 5, 2008 10:59 AM PDT
    Who Should Doctors Let Die In A Pandemic?

    Lets see

    Pedophiles, Drug Dealers, Corrupt cops would be a good start.
    Reply to this comment
    by navychief8 May 5, 2008 11:02 AM PDT
    rational1- Would you feel the same if YOU were the one with Alzheimers (or one of your loved ones)? When the shoe is on the other foot, sometimes our opinions change, don''''t they?
    Peace.

    Posted by berniepeders at 09:47 AM : May 05, 2008

    If I had Alzhiemers, I don''t know if I would even know what was going on.

    We are talking about a hypothetical scenario in which things have gone very bad, and we are worried about the survival of hundreds of thousands, amybe millions. In situations like this, I cully agree, triage is necessary. it is a terrible siuation. But if I were old and sick and I knew the effort spent to save my life could be better served and perhaps, those rexources could save five younger persons with their lives in front of them, then I would understand.

    Just my opinion.
    Reply to this comment
    by dwath1 May 5, 2008 11:02 AM PDT
    I think the list is more about priority. It may in the end have the same effect of euthenasia--the person dies. But, euthenasia is pro-active, you kill someone who is of no value (per your definition) or you expidite death for someone in acute pain which is still killing someone. But, when you have one doctor, ten people come in from a new born baby to an 85 year old who does not know who he/she is. The rest fall inbetween in terms of age and general condition. Let us say an oil company exec, a drug pusher, a tweaker (meth user), a car salesman, a preacher, a cook etc aged in various locations between the babe and the grampa. They will all die if not treated. Who do you treat first? By arrival? By future societal value? By ability to pay? You get the point. We ask the doctors to make these decisions on the spot. I am not so sure but we need to deal with these issues. Lest you think I am a supporter of euthenasia, abortion etc, I am not. But, life is not always easy and cut and dry.
    Reply to this comment
    by rational_1 May 5, 2008 11:02 AM PDT
    It is just a matter of time before we have a pandemic. I don''''t trust these other countries to control the bird flu, ebola, etc. When it hits, we are in big trouble.
    Posted by erasmus81 at 10:56 AM : May 05, 2008

    I agree with you erasmus. Given the global air traffic network things could spread very quickly. Imagine if one of these diseases mutates to become easily transmissible by inhalation and has a long-enough incubation time for it to spread widely before symptoms show up. Things could get really ugly really fast. Pandemics have happened numerous times in the past (eg. influenza in WWI) and it is probably just a matter of time.
    Reply to this comment
    by toolmangler-2009 May 5, 2008 11:10 AM PDT
    I died once already, I have 4 stents and cirrhosis, I am well over retirment age. My short term memory is not so good. where do you think I fall in this "list of preferred citizens", most likely, I would not even be on it
    Reply to this comment
    by usmcvn2 May 5, 2008 11:12 AM PDT
    It is just a matter of time before we have a pandemic. I don''''''''t trust these other countries to control the bird flu, ebola, etc. When it hits, we are in big trouble.
    Posted by erasmus81 at 10:56 AM : May 05, 2008


    I also agree Erasmus. And I think the "coming pandemic" will be
    much worst than the "great Flu pandemic" of 1918. Since people in the US already hate each other there
    will be mass murders, looting, rape ect.,ect.,ect., on
    a massive scale.

    I say unto you Sportfans......."Keep Your Powder Dry."
    Reply to this comment
    by rational_1 May 5, 2008 11:13 AM PDT
    I died once already, I have 4 stents and cirrhosis, I am well over retirment age. My short term memory is not so good. where do you think I fall in this "list of preferred citizens", most likely, I would not even be on it
    Posted by ToolMangler at 11:10 AM : May 05, 2008

    Well, sooner or later we''ll all fall off the list. It''s just a matter of time.
    Reply to this comment
    by usmcvn2 May 5, 2008 11:15 AM PDT
    They wil "save" the illeagls for sure. Can''t let the
    cheap slave die off. That will be 20 million slots taken away from born in the USA Americans.
    Reply to this comment
    by toolmangler-2009 May 5, 2008 11:17 AM PDT
    Well, sooner or later we''''ll all fall off the list. It''''s just a matter of time.
    Posted by rational_1 at 11:13 AM : May 05, 2008



    Too true, thats why I hate lists, Hitler made his list and 12 million plus died in the ovens. How long do you think we have before another "final solution" will be enacted?
    Reply to this comment
    by usmcvn2 May 5, 2008 11:22 AM PDT
    Undertakers will get rich! Invest now! Before its
    too late.

    Reply to this comment
    by erasmus81 May 5, 2008 11:26 AM PDT
    "where do you think I fall in this "list of preferred citizens", most likely, I would not even be on it" Posted by ToolMangler at 11:10 AM : May 05, 2008

    If I was a doctor, ToolMangler, you would be at the top of the list of people to save....well, almost.:)
    Reply to this comment
    by erasmus81 May 5, 2008 11:32 AM PDT
    Has anybody ever read Steven King''s "The Stand"? I normally don''t read his books because they are usually a bit whacky, but I liked this one. It was a little whacky in spots but I thought this would probably be exactly what will happen one day.

    After reading it, it took me a long time not to cringe when someone coughed.
    Reply to this comment
    by rational_1 May 5, 2008 11:39 AM PDT
    Has anybody ever read Steven King''''s "The Stand"? I
    Posted by erasmus81 at 11:32 AM : May 05, 2008

    I have erasmus, but a far superior book in my opinion is one written by George Stewart in the 1940s called Earth Abides, that details one man''s life after the fall of civilization (ironically after a pandemic). Check it out on Amazon.com for a synopsis.
    Reply to this comment
    by erasmus81 May 5, 2008 11:48 AM PDT
    Posted by rational_1 at 11:39 AM : May 05, 2008

    Thanks, I will.
    Reply to this comment
    by impeach_w May 5, 2008 11:51 AM PDT
    Wow, I understand the logic but I can say that when I take my sick grandma to a hospital and they say no sorry your too old. Any and all who try to prevent a doctor from healing a patient with life threatening condition can be legally shot (remember being shot is also a death sentence in this situation). No amount of homeland security firepower can make this plan work against a panicked society with a human drive for survival. This is only one one many incidents that would cause our society to unravel. I put forth the notion that the folks on this list to stop paying taxes as you are officially second class citizens and the government has no plans to help you in a pinch and only to let you die or worse. What to do with all those who are infected and untreated? Since we won''t help them, Do we Let them continue to spread infection or initiate the secret part or the plan? Protect your health and your rights: buy Guns, ammo, food, water, medicine, and your own copy of the constituion with bill of rights. None of these will be easy to obtain at some point in your lifetime (likely right at the end).
    Look, We all have the same right to get treatment in this situation. Those with guns can ensure those rights are never taken.
    Reply to this comment
    by impeach_w May 5, 2008 11:57 AM PDT
    I thought of some others options besides pulling guns or shooting folks! Here they are: Let me know if you have some more.

    Ask nicely.
    Call your insurance company
    Sue them (yes,during the pandemic.)
    Die.
    Reply to this comment
    by ringading3 May 5, 2008 11:57 AM PDT
    Whack registered DumboCrats first, make the world a better place. Liberalism is a Mental Disorder!
    Reply to this comment
    by providence_8 May 5, 2008 11:58 AM PDT
    Fear in an pandemic is really bad. A solution is go to www.shipwrecksoul.blogspot.com for answers. This will help with any fear!
    Reply to this comment
    by demslie May 5, 2008 12:09 PM PDT
    Whack registered DumboCrats first, make the world a better place. Liberalism is a Mental Disorder!

    Posted by RingADing3

    I agree. The irrational fear that causes Democrats to be endlessly negative and angry is the reason for this %u201CStory%u201D. Is this %u201CStory%u201D really important to the average American Voter? No, but it is vitally important the Self Absorbed, Negative, Angry, Atheist, Anything Sexuall Democrats who see a Government Conspiracy around every corner.
    Reply to this comment
    by libh8er May 5, 2008 12:14 PM PDT
    Whose to say the DOCTORS will be around to make those decisions? Seems to me that that a good percentage of them will be the first to go.
    Reply to this comment
    by impeach_w May 5, 2008 12:16 PM PDT
    Impeach_w is a registered Republican Thank you. I just have my eyes open to what is going on with the idiots on both sides in Government. Bush and Cheny are Evil and the alternatives only suck
    Reply to this comment
    by bobnjersey May 5, 2008 12:23 PM PDT
    do these rules apply to members of congress too?
    Reply to this comment
    by bobnjersey May 5, 2008 12:26 PM PDT
    [Whack registered DumboCrats first, make the world a better place. Liberalism is a Mental Disorder!]
    [Posted by RingADing3 at 11:57 AM : May 05, 2008]

    rabid conservatism ... of the neocon variety ... is a documented personality disorder.

    http://home.cc.umanitoba.ca/~altemey/

    what research to you have on liberals?
    Reply to this comment
    by ringading3 May 5, 2008 12:37 PM PDT
    Howard Dean, who could not win on his run, has now decided that your votes don''''t count! He and his hand picked "SUPERDELEGATES" will decide what is best for you. Now shut up and be good little DumboCraps! Florida and Michigan have been "Bad", so now they get to sit in the corner! YeeeeHaaaaa
    Reply to this comment
    by usmcvn2 May 5, 2008 12:48 PM PDT
    During a pandemic, to just let the elders die off
    without trying to help them, is the same as the destruction of "Wisdom".

    Add to the destruction of "Wisdom" a forthcoming GOP
    book burning and we have the end of the free world.

    No Human is expendable based on age.
    Reply to this comment
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