Public Health Emergencies and Legal Standards of Care

[tetano]

Jama
Vol. 303 No. 18, May 12, 2010


To the Editor: In their Commentary, Mr Hodge and Ms Courtney1 proffered a public health legal standard of care during emergencies. This is problematic for 2 reasons. First, it is unclear what principles ought to underlie a determination of fair treatment in accordance with communal or public health interests. Second, a physician who does not conform to this nonmedically indicated standard of care may arguably be liable for medical malpractice.

Just as there are no value-free medical criteria for allocation of scarce resources, there are no value-free public health criteria.2 The cited example of withholding ventilators from specific patients only amplifies the complexity of ethical (rather than legal) decision making. In 2008, the New York State Department of Health convened a working group that issued guidelines proposing to both withhold and withdraw ventilators from patients with the highest probability of mortality, in order to benefit patients with the highest likelihood . . .

http://jama.ama-assn.org/cgi/content/short/303/18/1811?rss=1

 

[tetano]

Re: Public Health Emergencies and Legal Standards of Care

Jama

Vol. 303 No. 18, May 12, 2010

In Reply:

Mr Bhattacharya raises ethical and liability concerns with our Commentary on the legal standard of care during crisis situations. We agree with the quintessential value of ethics in developing and implementing a crisis standard of care. Our concept of a legal standard of care in emergencies builds on the comprehensive work of the Institute of Medicine (IOM) committee,1 which explicitly noted the role of ethics in crisis care planning and response efforts.

In developing its strategy for allocating ventilators in emergencies, the New York State Task Force on Life and the Law acknowledged "ethics cannot be set aside during a public health disaster."2 Bhattacharya takes specific aim at the task force's conclusion that ventilators may ethically be withdrawn or withheld from patients with little chance to survive in emergencies to benefit those with a higher likelihood of survival.2 He proposes that other criteria may be reasonable, including allocations . . .

http://jama.ama-assn.org/cgi/content/short/303/18/1811-a?rss=1