Tuesday, May 06, 2008

Fear And Loathing Of Pandemic Triage


# 1954



The backlash over Monday's announcement of triage rules during a pandemic have already begun.  Some letters to the editor, blog musings, and newspaper articles are damning the plan before the ink has had time to dry.



A good example comes in this letter to the editor of the San Francisco Chronicle.


" It's one thing to acknowledge the reality of scarce resources and another to identify in cold, cruel language those for whom life no longer matters. The elderly are already cast aside in our society and this recommendation confirms it. "



Another comes from the business section of today's Charlotte Observer.



Plan for long life, without pandemic



Should doctors let people older than 85 die in a flu pandemic?


A Monday news story saying a U.S. task force recommends denying lifesaving care in a pandemic or other disaster to some folks -- including healthy people above 85 -- was unsettling.


They're talking about my mother, soon to be 86. My friend Karen's father, who is 92. Another friend's grandmother, 102.


These people live life joyfully, with their minds and hearts intact. My mother relishes foreign travel. Karen's father loves bird watching. The 102-year-old grandmother plays a mean hand of bridge.


Financial planners, who routinely urge clients to base their planning on living to 95 or more, were aghast when I told them the news.



There is no doubt about it, triage is not pretty.  But it is necessary.


I suppose those who have never had to make a life or death decision, deciding who gets care and who doesn't, can be forgiven for not understanding.   The concept that there might not be enough medical resources to tend to everyone hasn't really registered.


But in a severe pandemic, the decision may not be between deciding whether to give a ventilator to an 85-year-old man or a 7-year-old girl . . . it may be which one of four desperately ill children will get the only available ventilator.


In a pandemic, such as we saw in 1918, the number of critical patients will far exceed the number of ventilators or hospital beds.   Hundreds of thousands of people could be seriously ill at the same time.


Choices will have to be made, and while it may seem callous to decide in advance who will receive care and who will not, it is imperative that we  have uniform rules in place.


If no officially sanctioned guidelines were in place, and it were left to the discretion of each doctor, then physicians would be open to all kinds of lawsuits from bereaved family members.   Triage, and the delivery of medical care, would bog down as individual cases are decided by arbitrary rules.  It would be chaos.



Some of the comments I've seen in the past 24 hours intimate that we'd use a pandemic as an excuse to kill off the elderly, the chronically ill, or those with mental impairments.  They somehow believe that authorities are waiting in gleeful anticipation to rid our society of those who may no longer be as productive as they once were.



The world, and particularly the Internet, loves a conspiracy theory.  I'm sure that these theories play well among many readers.


All of this highlights how poorly the threat of a pandemic is understood by the average person in the country, or around the world.   Those who read flu blogs, or who read flu forums, or who are involved in pandemic planning know the score.    But they constitute a small minority of society.


Despite nearly three years of warnings, most people don't take pandemic flu seriously.   The fault lies mostly with the major media, who have all but ignored the story for the past 18 months.    


We need to do a better job educating the public on the realities of pandemic influenza, even at the risk of scaring them.  Right now, most are woefully uninformed and unprepared, and should a pandemic come, they will be liabilities instead of assets in the fight against it.


If authorities want to maximize civil order and cooperation during a pandemic, they need to find ways to aggressively educate the public as to what they can expect in a pandemic and the limitations governments will have in dealing with a crisis. 


After all, an educated public is a reasonable public.

1 comment:

L. R. MacGregor said...

I am appalled at these plans the "powers that be" have decided upon. While they might not be prepared for such a horrific pandemic I am extremely suspicious of how the goal a few years ago or less went from plans to make every effort to treat almost everyone to such limited expectations. I also don't like the attitudes of many health care workers on the net who think everyone should take these tough measures in stride. Do you honestly think most Americans are going to tolerate it?! There will probably be a tremendous amount of civil unrest.
And I wouldn't dismiss it as totally paranoid to believe that some individuals would be looking forward to knocking of a large portion of the world's population. There are several well known people who have voiced their opinions that they would like to see the world population much reduced. One even stated that after he died he would like to come back as a plague to knock off a huge population from the planet. Some of the environmentalists have even stated that humankind should die off and leave the planet to the animals and the rest off nature. And there are think tanks working on ways to reduce the world population. I have read some of their reports online from their own websites not from some websites devoted to conspiracies. Many people don't trust governments in general nor do they trust such entities as the World Trade Organization. They aren't necessarily conspiracy buffs. No, instead they view these entities without rose-colored glasses. The world is full of people with evil purpose and it's not unbelievable that they would make a point of finding ways to place themselves in positions of power.
I would suggest that everyone remember what often happens under totalitarian governments even mildly socialist governments. People lose control over their own lives in countless ways.