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):
Further NCBC resources on pro-life considerations for triage and rationing:
*note particularly the discussion of DNR protocols