By Alex Seghers
Louisiana Right to Life Director of Education

With the examination of treatment protocols that COVID-19 necessarily brought forth, the core concern which led to stay-at-home orders was the impact that overwhelmed hospitals would have on patient care. As especially seen in Wuhan, Iran, and northern Italy, the number of ventilators were short, causing doctors to make life or death decisions based on their patients’ best chance of survival. 

In March, when many stay-at-home orders began, the Washington Post took a look at the future of such decisions in the United States, particularly at the difference of triage and rationing protocols from state to state.

“…state and hospital plans often vary widely in how they deal with issues such as a patient’s age. Some state recommendations do not set specific age cutoffs for ventilators during rationing, while others explicitly exclude access for older people, with access barred to those ranging in age from 65 to 85. A Minnesota panel, for instance, recommended prioritizing children over adults, and young adults over older adults, while the New York group did not use age as a criteria in itself. Most plans include a list of serious conditions that would exclude someone from getting a ventilator if rationing were in effect, and many conditions are more common in the elderly, such as severe cardiac issues, kidney failure and metastatic cancer. In Maryland, avoiding discrimination is a major concern for those who drafted the guidelines, Daugherty Biddison said. She explained that disasters – epidemics, wars and attacks – tend to exacerbate society’s inequalities and in discussions about how to ration resources, there’s been tension among politicians, the public and ethicists about how to protect vulnerable groups.” 

These questions are very morally distressing to doctors, hospital patients, and those considering whether or not to let their elderly or immunocompromised family members go to the grocery store. The pro-life person should certainly view triage and rationing protocols as necessary and helpful measures in a pandemic, and the pro-life healthcare administrator should implement sound ethical principles when determining protocol for their hospital. 

But the language we keep hearing, like “maximizing population outcomes” or “providing the greatest good to the greatest number” is very utilitarian language, often used in social paradigms that are not pro-life. How do we maintain awareness of the possibility of utilitarian approaches and evaluate the means by which triage protocols seek to “maximize the greatest good?”

Thankfully, we have not fully seen strict rationing play out in the United States as we have seen in other countries during this crisis. To help with this idea of healthcare rationing for the remainder of this crisis and the next, here are some pro-life reflections and questions, drawn from the National Catholic Bioethics Center’s resources on Covid-19 (*Louisiana Right to Life is not a sectarian organization but appreciates the resources from this organization with pro-life expert ethicists):

• The ultimate standard and goal of triage and rationing should be to save human lives and to serve human health and dignity to the greatest extent possible consistent with the common good. 
  • Are the vulnerable and marginalized prior to the pandemic still being served and cared for?
  • Are the disabled patients who are already on oxygen and ventilators still being advocated for?
• Standards being created for limiting or directing treatment should be based on objective measures that best serve human life, health, and dignity. They should be applied in a non arbitrary, nondiscriminatory manner and only for the duration of the crisis. Categorical exclusions based solely on an individual’s age, disability, or medical condition (if it does not impact short-term COVID-19 survival) constitute unjust discrimination and are immoral.
  • Are the triage and rationing protocols accurate, complete, and based on the best standards such as the Sequential Organ Failure Assessment (SOFA) Score?
  • In establishing objective standards, have we eliminated grounds for bias or partiality as much as possible?
  • Are triage and rationing protocols as specific and limited as possible in terms of the resources to be rationed and the duration of time in which the protocol is in effect?
• Resources for patient care become increasingly valuable in times of crisis and shortage. 
  • In a healthcare perspective: are they doing everything they can to identify and access additional essential resources and to prioritize essential activities rather than profit?
  • In transferring resources from hospitals experiencing much less demand, are we making sure that they are still equipped for a future demand?
• Implementation process must have consistency, accountability, transparency, and regular review.
  • Consistency: not granting exceptions or exemptions, although there should be channels open for reasonable discussion of questions and concerns.
  • Accountability: the chain of authority to establish and implement protocols of triage and rationing should be clearly founded and communicated. Especially to healthcare professionals, patients, and families.
  • Transparency: standards for protocol should be publicly accessible and proactively explained. 
  • Regular review: ethical and clinical principles should be reviewed and adjusted as necessary to save more lives, help more patients, reduce moral distress, and increase public trust and support.

Further NCBC resources on pro-life considerations for triage and rationing:

• Thinking through the rationing of ventilators
• Triage Protocol Guidelines
• Ethical Concerns with current COVID-19 Triage Protocols

*note particularly the discussion of DNR protocols