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Difficult Decisions Ahead For Hospitals And States As Coronavirus Cases Surge, ICUs Fill

PITTSBURGH (KDKA) -- As COVID-19 infections surge and intensive care units fill, states and hospitals may have to make difficult decisions.

"It was foreseeable," says Carnegie Mellon University's Center for Ethics and Policy medical ethicist Alex John London, Ph.D. "It was one of the most important things we were trying to avoid."

States must figure out how to distribute patients among hospitals, and hospitals need to determine how to stretch their supplies and personnel.

"You can ask manufacturers to manufacture more ventilators. You can stop elective procedures and try to create more hospital beds that you can fill with COVID patients. It's very difficult to train new personnel," he said.

Earlier in the pandemic, staff from less hard-hit areas could travel to hot spots. But now it's different.

"Lots of places are dealing with high levels of demand. And so we're reaching a point where there's a concern about how much flexibility we have in moving providers around the country," he said.

Organizations — such as the American Medical Association, the National Academy of Medicine and the American Nurses Association — warn that critical decisions will have to be made about how to use limited resources to do the most good for the most people.

"When you get into that situation, you want to have prepared. You want health care providers to be making those decisions not off the cuff, on the basis of their own values," London said. "You want them to be making difficult decisions that are implementing a policy that you've prepared in advance."

For instance, decisions might be based on an individual's likelihood of dying, but not on blanket criteria — such as age or disability or even simple metrics such as saving the greatest number of people when certain people play a role in helping others through the pandemic.

"They have to be simple enough that you can implement them in real-time. They also have to be something that you can justify to the public," said London. "There's a real challenge to show deep respect for every individual life, where every individual is irreplaceable, but you're in a situation in which you simply cannot save everyone."

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