Thread by @DrSamuelBrown

I'm thinking about the chatter about #COVIDー19 #EOL conversations. There's a risk here that we should say out loud. The moral satisfaction that can come to clinicians from encouraging a "good" death may mix the role of the Crisis Triage Officers (making fair and just

assessments for a community of how to share limited life support capacity) with the clinician (seeking care that is helpful and true to their specific patient as a person. For an individual patient, COVID is just ARDS. It is not the moral distress and even discomfiture (used

with its dictionary definition) that we experience about this awful pandemic. It is ARDS. So if walking the path of treatment for ARDS is true to them as a person, the bedside clinician should offer it unless and until a formal Triage team is forced to restrict such care.

It's too easy for bias to slip in and for mixed motives to draw our mind from our best selves. So from my perspective, the relevant framing is something like "COVID-19 has us all feeling nervous and even afraid. It's got us all thinking more about questions of life and death.

The lung problems COVID causes are like a condition we often treat in ICUs that we call ARDS. Many people recover, from ARDS after a long struggle on life support. Many do not recover. We may be at a crossroads here, where together we will need to decide which path to take.

For some the path will be to fight on, in hopes of recovery. For others, the path will be to focus on comfort and allow nature to take its course if we reach the point where your body would likely die without life support. As we think about these two paths that lead from where

we stand, which do you think feels most consistent with who you are as a person and where you are in the story of your life?" Nothing about ventilator shortages, nothing about how awful a pandemic is, just two people pondering together--however quickly and anxiously--

the big questions about the stories of our lives. If a patient chooses the path without life support, we work to honor them and provide for their comfort. Only those who would choose life support other things being equal would enter into any (we hope very unlikely)

problems of crisis triage. (I know that some situations may be too rapid to have this talk, but I have over the years been able to have this talk in many time-compressed circumstances.) I'm offering this not by way of criticism, but by way of what I hope is humanizing clarity.