Hard Choices Ahead

If a pandemic comes, the American people are in for a genuine shock. We are used to having modern medicine available, with hospital beds, antibiotics, and even ventilators should we need them. The idea that those things might not be available hasn't sunk in for most Americans. Even those who watched in horror at the destruction of New Orleans, still believe `it can't happen here'.

What happens when a hospital has 10 ventilators and 100 patients who will die without one. Simple answer: 90 will die. The tougher question is, which ones?

How do we decide who gets a ventilator and who does not. Once someone is placed on a vent, if someone else shows up who is younger, or richer, or more important . . . do we take the first person off the vent and give it to them?

At what point do we decide that a patient isn't likely to survive, and remove the vent so someone else can have it?

These same decisions will have to be made regarding Tamiflu, antibiotics, hospital beds, and someday even a vaccine. All will be in short supply.

The odds are, a few days or weeks into a pandemic, if you go to a hospital with a sick child, you will be turned away.

Terrible decisions may need to be made in the home, too. If someone at home gets sick, who exposes themselves to them in order to try to nurse them back to health? Does that person stay quarantined with the sick person, to spare the rest of the family?


And the biggest moral,ethical, and potentially legal dilemma people are likely to run into during a pandemic is that of a flu victim, in extremis (near death), whom you could spare a good deal of pain and agony by administering a sedative or a narcotic.

We’re not talking a `normally lethal’ dose. Just enough to take the edge off, perhaps reduce the coughing spasms, and even allow the patient to sleep.

But implicit in doing so, is the understanding that these meds may depress the Central Nervous System, depress respirations, and will likely hasten their death by a few hours.

While this is done routinely for end stage cancer patients by many doctors, and may be seen as humane by some, could you do it to (or for) your spouse or child?

On the other hand, could you allow a loved one to continue to suffer, knowing you had at your disposal medicine that would calm them down, reduce their pain, and allow them to rest easily?

ARDS is a terrible way to go. Respiratory distress, spontaneous pnuemothorax, pulmonary edema, wracking coughs, internal bleeding . . .

What price should a dying patient pay for another hour or two of life. What matters more, quality or quantity of life. If we are talking only a few hours difference, which would you choose?

I know my answer, as I have crossed this bridge before.

But you need to seriously think about it.