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What If Patients, Not Doctors, Could Decide Who Gets a Ventilator?

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  • What If Patients, Not Doctors, Could Decide Who Gets a Ventilator?

    Source: https://slate.com/technology/2020/04...s-doctors.html

    What If Patients, Not Doctors, Could Decide Who Gets a Ventilator?
    By Christine Henneberg
    April 01, 20208:32 PM

    Consider the nightmare scenario you’ve heard many times by now: Twelve patients with COVID-19 arrive in the ICU needing emergency mechanical ventilation. Only six ventilators are available. Which patients should the doctors place on ventilators? Which patients should be left to die?

    This is a nightmare in two parts: One is the overflowing hospital, the vision of sick patients waiting for the medical care or equipment that they might not get in time. The other is the decision-making, in which doctors must choose who lives and who dies.

    The U.S. is now closer to this scenario than we have ever been in the history of modern medicine. But there might be a way to avoid it, or at least substantially mitigate it—a strategy that has nothing to do with testing, treating, or containing the coronavirus. It is a strategy that is cheap, and fast, and not actually that radical: Make sure every American has an advance directive.

    An advance directive (sometimes called a living will) is a document that details a patient’s wishes in the event that he or she becomes critically ill. They can vary quite a bit, but a standard advance directive always addresses the question of whether or not the person desires life support—i.e. medicines and machines to keep the person alive when organ systems are failing.
    The most critical component of life support in many cases, and certainly in the case of COVID-19, is mechanical ventilation.

    How would you respond if you were asked the following question: In the next 12 months, in the event that you develop a life-threatening respiratory illness requiring mechanical ventilation (whether from COVID-19 or another illness), would you prefer:

    A) Mechanical ventilation and intensive care , with the goal of sustaining life by all medically effective means

    B) A time-limited trial of mechanical ventilation, then transition to other, less burdensome treatments

    C) No mechanical ventilation or burdensome treatments of any kind—just focus on comfort?

    This question may seem hard or complicated to answer, and for most people it is. Multiple factors will likely influence your choice, including your age, how much longer you expect to live, your religious or spiritual beliefs, your family and other relationships. In light of this difficulty, and the rapid escalation of the COVID-19 crisis, experts are rightfully urging us to bring up the subject with our families and loved ones. But to have a real impact—both for individuals and the wider population—this conversation can’t just be between family members. We have to go one step further, and make sure everyone is having this discussion with a healthcare provider. Now...
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