CHICAGO, Ill. – Shortages of ventilators and personal protective equipment mean many healthcare providers are going into battle unarmed. It’s sparked a heated debate behind closed doors about balancing efforts to save patients versus exposing doctors and nurses to the virus.
Who lives? Who dies? Who gets priority to a ventilator? All complex questions health providers are being confronted with.
“We've never had this situation before. This is unprecedented,” said Craig Klugman a professor of bioethics at DePaul University in Chicago.
Bioethicists say widespread infection, protective equipment and ventilator shortages are creating unique ethical dilemmas for healthcare workers.
“We will start to care for the person who is at risk of dying first,” explained Dr. Ricardo Gonzalez-Fisher, a surgical oncologist who teaches healthcare ethics at Metropolitan State University of Denver. “But if we have more people than resources that we have to. Try to save those that are savable.”
“The obligation for a healthcare provider to treat the patient doesn't necessarily have a limit,” said Klugman.
In Spain, some 13,000 medical workers have been infected. In Italy, more than 60 workers have died since the outbreak began.
“It's not just their life. They can assume this risk for themselves,” said Klugman. “If they don’t have the right equipment, they also have the risk of infecting other patients, other healthcare providers. Their family.”
Some health systems around the country are reportedly discussing unilateral do-not-resuscitate policies. It’s something that was debated during the Ebola outbreak in 2015.
Determining who gets treatment and who does not is something Klugman says is taken very seriously.
“We think about it very carefully and with great deliberation.”
In Italy, that meant denying some care to the elderly in favor of the young.
Klugman says in Illinois, a pandemic flu plan created a decade ago includes care procedures built around ethical frameworks and algorithms that help decide who should for example, get a ventilator.
“We have to consider things like what is our most important value. So, the value that we're considering is maximizing the number of years of life that we can save,” said Klugman.
Ultimately, a balance must be struck.
“You have to make sure that the benefit of the patient overrides the harm or the risk that you're getting in,” said Dr. Gonzalez-Fisher.
Otherwise, bioethicists say there may not be enough first responders to treat the infected.
“When you call 9-1-1 because your loved one can't breathe, there will be nobody coming. That's the worst-case scenario,” said Klugman.