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Bird Flu: Tough Decisions, No Plan
Bird Flu: Tough Decisions, No Plan
Denis O'Hayer Reports
Web Editor: Denis O'Hayer
Last Modified: 5/9/2006 9:36:44 PM
Right now, the U.S. hasn't seen even one case of bird flu. But, every day, emergency rooms and intensive care units, like those at Emory University Hospital, are jammed.
So, if a pandemic sent patients flooding in, doctors here, and in every U.S. hospital, would face agonizing life-and-death choices.
Dr. Walt Orenstein of Emory's Vaccine Center said it would be something like field hospitals in wartime. Without enough resources to meet the demand for care, hospitals might have to adopt what Orenstein called "alternative standards of care." He said that might even force doctors to decide not to treat some patients, "where one would have to make judgments about survivability, productivity -- very difficult moral and ethical kind of decisions."
Orenstein is one of many medical leaders calling for a plan and uniform standards to help make those difficult decisions. "Hopefully, we'll never have to come to that," he said. "But we should begin discussing that now, and come to some societal agreements, before we have to do so."
Some pandemic planning is underway. Last month, there was a first response drill at Hartsfield-Jackson Airport. But, once patients arrive at hospitals, they would run into the supply crunch. There's still no bird flu vaccine, nowhere near enough hospital beds, and, according to medical ethicists John Banja and Nancy Berlinger, no clear standards to decide who gets what we do have.
Dr. Berlinger is a Ph.D. at the Hastings Center, an independent bioethics research institute in New York. She warned it won't be easy to reach consensus on the distribution rules, because the risks for individuals and communities will vary and everyone will demand priority. As Berlinger put it, "It's like Lake Wobegon -- all the children are above average. Well, 'I'm at highest risk, and I need the most.' And I don't know how that is going to be sorted out. But it has to be sorted out well in advance of any declared health emergency, because you will have chaos."
And beds won't be the only thing in short supply. Influenza is a respiratory illness, so there will be a big demand for respirators, for instance, to keep patients alive.
Emory University Hospital, for instance, uses about 60 ventilators on a busy day. A worst-case pandemic would overwhelm everyone's supply. Berlinger suggested decision-makers might want to consider a kind of "motor pool" which would collect all the ventilators from all the hospitals in a given area and distribute them where the needs are greatest.
But Dr. Banja, another Ph.D., and a clinical ethicist at Emory, warned even that won't make the decisions easy. He said, "I think it's going to be a really difficult situation just on the clinical level of saying this person is sicker than that one is sicker than that one."
Last week, federal disaster planners warned local leaders they have to make their own plans and rely on them. DeKalb County Commissioner Connie Stokes has added bird flu to the agendas of her community meetings. And she said DeKalb's Health Department has been developing guidelines for a long time now. Stokes promised, "There will be a plan, and there is (sic) already drafts of these."
When asked if she's afraid some people will be told they must go without care, Stokes said, "No, I'm not afraid that that's going to happen; because I'm working hard with other professionals to make sure that that does not happen."
But Berlinger warned there's still a lot of difficult work to do. "Are we all ready? Absolutely not," she said. "And we're getting mixed signals."
Berlinger agreed with the Feds that local governments and individuals must bear a lot of the planning burden. But, she faulted the recent federal report for what she called a lack of leadership -- something she said could be dangerous in a pandemic.
"When the take-home message in every paper was 'You're on your own,' this does not inspire the citizenry. What does that say to people? That, 'I'm gonna have to fight for my own.'"
Banja added a warning of his own: even if we do develop clear ethical standards for distributing scarce health care resources, he said, "We're still going to have a lot of experimentation. You're still going to have a lot of people flying by the seat of their pants. There's still going to be catastrophes. There's still going to be tragedies."
Health officials agree we all have a responsibility to make our own plans, too. That by itself could save lives--the ones in your home. For more on how to make your plan, check the links on our website.
The hope is for time, to mix medicine with justice.