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Published: Monday, 5/12/2008

Who would be saved?

SOME public-health decisions are loaded with political and legal mine fields, but none more so than the dilemma of deciding who gets medical treatment when not if a healthcare disaster hits and there are simply not enough resources to treat every affected individual.

Avoiding the matter entirely is easier than confronting it head-on but that does little to prepare for the eventuality. Recently, an influential group of physicians favoring preparation over punting tackled the issue directly to decide who should receive lifesaving care in a flu pandemic or similar disaster and who should not.

Unlike other groups that have dealt in general with how limited resources should be doled out to particular patients, the latest report offers what may be the most detailed recommendations to date.

And even if its specific recommendation on who should be excluded from treatment stands no chance of passing legal muster, it ought to at least make the public aware that some excruciatingly difficult choices would have to be made.

If scarce resources, including ventilators, medicine, doctors, and nurses, are to be used in a uniform, objective way, said the panel, whose members came from prestigious universities, medical groups, the military, and government agencies, everybody in the medical community needs to be thinking in the same way.

Even if that means healthcare rationing.

The latest task force to weigh in on who may have to forgo lifesaving intervention, owing to deficiencies in [medical] supply or staffing, relied on input from the Department of Homeland Security, the Centers for Disease Control and Prevention, and the Department of Health and Human Services. It came up with proposed guidelines for medical triage teams to employ that a hospital association likened to a battlefield approach in which finite resources are reserved for those most likely to survive.

The suggested blueprint for hospital officials and medical professionals who would be besieged in a widespread disaster is starkly cold, recommending that patients be excluded from treatment who, for example, are older than 85, severely burned patients older than 60, severe trauma patients with critical injuries, and patients with severe mental impairment or severe chronic disease. In other words, people at high risk of death or slim chance of long-term survival would be out of luck in a pandemic.

Obviously, there are real ethical concerns about any suggestion that anyone be left to die during a medical crisis, but hospitals and health care professionals need some guidelines to fashion their own preparedness plans before the grim battle begins.

It is an acutely difficult issue to consider, but better to deal with it before the fact than after a mass disaster strikes, challenging control with chaos.

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