Glad to say, in light of #COVID19, many are #flatteningthecurve with social distancing, frequent hand washing, and other practices.
Though this is likely to reduce the rationing of hospital beds, ventilators, and provider hours...it is not likely to eradicate such rationing. 1/
Though this is likely to reduce the rationing of hospital beds, ventilators, and provider hours...it is not likely to eradicate such rationing. 1/
My dissertation (which became the book below) acknowledged impossibility of not rationing in some sense. We have virtually unlimited care needs and limited resources. But because we rarely think about this reality...explicit rationing can be unsettling. 2/
amazon.com/Too-Expensive-…
amazon.com/Too-Expensive-…
Italy is now facing this reality...and intentionally preferring the young to the old. This is deeply problematic and arguably unjust. One major problem here is many health care providers and institutions are uncritically utilitarian in their approach. 3/
Italian doctors aren't "forced" to take any particular approach but here's one generally accepted principle: help those who can likely benefit from treatment first. If an older person is not likely to benefit, tragically, they might not get the last ventilator in the hospital. 4/
But that vent should not necessarily go to a younger person who is more likely to benefit. It could also go to an older person who is more likely to benefit.
Far too often, a Quality-Adjusted Life Year (QALY) model of rationing care leads to ageist (and ableist) results. 5/
Far too often, a Quality-Adjusted Life Year (QALY) model of rationing care leads to ageist (and ableist) results. 5/
QALY model assumes added life years (along with quality of life) are to be taken into consideration when determining whether and how patient would likely benefit from ventilator. Especially if one believes we ought to prioritize the most vulnerable...it is a terrible approach. 6/
Such an approach also leaves no room for values (so strong in other cultures) associated with respect for elders. Even to the point where they in some sense have an even stronger claim to limited resources than younger folks. One might call this the anti-#OKBoomer mentality. 7/
The US doesn't have a standard way of approaching these problems. We have federalism and radical pluralism. Local decisions will be left to medical systems, hospitals, and even individual medical teams. Please, #medtwitter, resist the lazy slouch to QALY-like utilitarianism. 8/
Resist it not only with respect to ageism but also ableism. Your job is to give beneficial care to your patient. It is not to decide whether any underlying health conditions or disabilities make their lives of less worth than patients without such conditions or disabilities. 9/
Back to #flatteningthecurve. We must all be in solidarity with populations at risk for having care rationed.
Again: social distancing, hand washing, etc.
When we selfishly reject these practices, we make it more likely the vulnerable will not get the care they need.
/FIN
Again: social distancing, hand washing, etc.
When we selfishly reject these practices, we make it more likely the vulnerable will not get the care they need.
/FIN
