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A Medical Ethics Framework to Support Decision-Making in the Allocation and Distribution of Scarce Medical Resources During Pandemic Influenza

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  • A Medical Ethics Framework to Support Decision-Making in the Allocation and Distribution of Scarce Medical Resources During Pandemic Influenza

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    Texas patients deemed too sick to recover or hospitalized in small or rural facilities with staffs not well trained on sophisticated medical equipment would be less likely to get scarce medical resources, such as ventilators, or breathing devices, during a flu pandemic based on a plan the state is considering.

    The state also would discourage widespread use of antiviral medications to prevent or treat a pandemic flu, giving priority to those most vulnerable to illness and death. That means healthy people would have to wait until more supplies of medications become available.

    The report recommends that vaccines first go to health care works and priority also be given to the vulnerable.

    Those are among the highlights of a proposed pandemic flu plan the Department of State Health Services is seeking public comment on by 5 p.m. Monday. It is designed to guide ethical decision making when state officials distribute scarce resources, such as ventilators, antiviral medications and vaccines.

    You can view the plan on the state?s website e-mail comments on the plan to Bruce.Clements@dshs.state.tx.us.

    The plan envisions patients in hospitals that are not equipped to handle ventilated patients being transferred to facilities that can care for them. Asked how likely that would be in the event of a pandemic more severe than the recent H1N1 swine flu pandemic, which has fizzled out, Dr. Adolfo Valedez, the state?s assistant health commissioner over the prevention and prepardness services division, said ?very likely.?

    He acknowledged that the plan could be controversial among members of the public because anytime scarce resources are distributed, tough decisions must be made.

    ?In a public health emergency, that changes our thinking from the individual patient to benefiting the public health at large,? Valadez said. ?You just don?t give a ventilator to a patient, you need to have the pulmonologist, the respiratory therapist and the critical care nurse? at the facility to care for the patient.

    The 17-member working group that produced the report, chaired by Dr. Jeffrey L. Levin, chairman and professor of occupational medicine at the University of Texas Health Science Center at Tyler, struggled with the ventilator recommendation and ?tried to frame that in the best way possible,? Levin said.

    ?Nothing is ever perfect and we depend on the feedback of all stakeholders,? Levin said.

    Valadez said he doesn?t expect the report to change substantially before its finalized, probably late next month

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