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Editor, Senior Moderator
Source: http://www.thespec.com/News/Local/article/640626
HHS sets pandemic priority list
September 24, 2009
Joanna Frketich
The Hamilton Spectator
(Sep 24, 2009)
A list of who gets life-saving treatment first during a flu pandemic has been created by Hamilton Health Sciences.
It's believed to be the first hospital in Canada to make clear rules about who gets intensive care to try to save them versus who gets palliative care while they die if the health-care system is so overwhelmed by flu that there aren't enough beds, staff or equipment to provide critical care to all who need it.
"We felt because these are ultimately tragic choices that it was better to be prepared for them," said Andrea Frolic, ethicist at Hamilton Health Sciences and the facilitator of the protocol.
"Clear processes of decision-making and clear criteria would protect patient rights and protect the patient from idiosyncratic decision-making by a single individual. It would also protect our health-care workers who are going to be faced with unimaginably stressful circumstances if this ever happens."
The list was created over 10 months with input from front-line staff, doctors, ethicists, lawyers, human rights experts and the hospital's board and published this week in Healthcare Quarterly. It gives priority to five groups of people.
1. Health-care workers and other essential services such as firefighters and police officers because they have the skills to save others once they're better.
2. Those who caught the flu at work, particularly essential service workers, because they put themselves at risk to save others.
3. Caregivers of children, disabled adults or the elderly to minimize societal disruption.
4. Young people because they haven't had a chance to live their lives yet.
5. Those most likely to survive that particular strain of flu.
The decision would be made by a team of three including an ICU doctor, an ICU staff and a health-care worker from another part of the hospital.
"What this situation raises is what we call in ethics a world of competing sorrows," said Margaret Somerville, founding director of the McGill Centre for Medicine, Ethics and Law. "It doesn't matter what you do, you're still going to do some harm. You're choosing between harms."
It will always be controversial because not everyone will agree with who gets priority. But it's better to have a plan, says Somerville.
"At least they're trying to address the problems upfront rather than pushing them under a mat and saying 'We'll hope we can muddle through,'" she said.
"That's the better avenue to take."
HHS' plan also raises questions about who should make these decisions.
It's expected that during a severe pandemic -- unlike H1N1which has been mild so far -- more than twice as many patients will require intensive care with less than half the usual staff to provide it and far too few beds and equipment.
Should each individual hospital have a plan to determine who gets critical care first or should there be a provincial or national protocol?
"All of these criteria we acknowledge are controversial," said Frolic. "It is not clear that there's a right or wrong in all of this... This opens up a much bigger ethical issue which is about how much autonomy should individual organizations have in making decisions about their practices. If HHS has these criteria and Niagara Health System has these criteria, is that really fair and equitable given that we're all funded by the same ministry? My hope is that by stirring the pot a bit and making our criteria public, we can continue to have this dialogue."
jfrketich@thespec.com
905...
HHS sets pandemic priority list
September 24, 2009
Joanna Frketich
The Hamilton Spectator
(Sep 24, 2009)
A list of who gets life-saving treatment first during a flu pandemic has been created by Hamilton Health Sciences.
It's believed to be the first hospital in Canada to make clear rules about who gets intensive care to try to save them versus who gets palliative care while they die if the health-care system is so overwhelmed by flu that there aren't enough beds, staff or equipment to provide critical care to all who need it.
"We felt because these are ultimately tragic choices that it was better to be prepared for them," said Andrea Frolic, ethicist at Hamilton Health Sciences and the facilitator of the protocol.
"Clear processes of decision-making and clear criteria would protect patient rights and protect the patient from idiosyncratic decision-making by a single individual. It would also protect our health-care workers who are going to be faced with unimaginably stressful circumstances if this ever happens."
The list was created over 10 months with input from front-line staff, doctors, ethicists, lawyers, human rights experts and the hospital's board and published this week in Healthcare Quarterly. It gives priority to five groups of people.
1. Health-care workers and other essential services such as firefighters and police officers because they have the skills to save others once they're better.
2. Those who caught the flu at work, particularly essential service workers, because they put themselves at risk to save others.
3. Caregivers of children, disabled adults or the elderly to minimize societal disruption.
4. Young people because they haven't had a chance to live their lives yet.
5. Those most likely to survive that particular strain of flu.
The decision would be made by a team of three including an ICU doctor, an ICU staff and a health-care worker from another part of the hospital.
"What this situation raises is what we call in ethics a world of competing sorrows," said Margaret Somerville, founding director of the McGill Centre for Medicine, Ethics and Law. "It doesn't matter what you do, you're still going to do some harm. You're choosing between harms."
It will always be controversial because not everyone will agree with who gets priority. But it's better to have a plan, says Somerville.
"At least they're trying to address the problems upfront rather than pushing them under a mat and saying 'We'll hope we can muddle through,'" she said.
"That's the better avenue to take."
HHS' plan also raises questions about who should make these decisions.
It's expected that during a severe pandemic -- unlike H1N1which has been mild so far -- more than twice as many patients will require intensive care with less than half the usual staff to provide it and far too few beds and equipment.
Should each individual hospital have a plan to determine who gets critical care first or should there be a provincial or national protocol?
"All of these criteria we acknowledge are controversial," said Frolic. "It is not clear that there's a right or wrong in all of this... This opens up a much bigger ethical issue which is about how much autonomy should individual organizations have in making decisions about their practices. If HHS has these criteria and Niagara Health System has these criteria, is that really fair and equitable given that we're all funded by the same ministry? My hope is that by stirring the pot a bit and making our criteria public, we can continue to have this dialogue."
jfrketich@thespec.com
905...
