Scarcity, Choice, and Triage

The National Post has an article about how people are facing choices about death because of CoVid-19.

Here's the important quote:

A letter was shared widely last week from a Michigan hospital, for example,

outlining its triage criteria for intensive care, making clear that other conditions

such as cancer, heart disease or trauma could make a patient “not eligible” for

intensive care or mechanical ventilation.

“Patients who have the best chance of getting better are our first priority,” read

the public letter from Henry Ford Health System.

 

The article then discusses attempts to quantify (objectively!! Hah!) expected future years of quality-adjusted life. My take:

• Scarcity is rampant (time, ventilators, healthcare workers, space, supplies) [Economists discuss this all the time for all goods and services]
• Scarcity means people have to make choices, like it or not. [Economists also discuss this all the time; indeed some people say that economics is the study of choice due to scarcity.]
• Those choices, when it comes to a pandemic, involve triage, deciding who to treat and how (recall gripping scenes from MASH that captured this effect to some extent).
• You can call them "death panel" decisions if you want, but someone has to decide who gets what treatment. What will be their decision rules?
• The CV19 triage decisions are analogous, but on a much larger scale, to decisions about who gets what transplants.
• The linked article talks about being neutral, objective, etc. I call BS. There are normative values embedded in these measures.
• Even though I'm relatively healthy, and even if I might have as much as 15-20 years left, I could very easily lose out in triage to others who are younger, have more 'productive' years ahead of them (i.e. will work at real jobs, earning money and paying taxes, and not lounge around writing and acting). E.g., I'm over the 75-years-old criterion applied in some parts of Italy. It's not 'agism', and I understand it, but the realism of it is a huge gutwrench.

It is this situation that leads many of us elders (a term I'm coming to like a lot more than seniors) to:

• wear masks,
• use sanitizers,
• wash a lot,
• avoid crowds (especially in confined areas),
• do large shoppings at odd hours to avoid having to be in stores too often,
• isolate a great deal,
• pay for delivery so we can avoid stores, etc.

I know I'm going to die at some point, but I'd rather not have it be after I've been lying on a table, realizing that some young ER doc or nurse has triaged me into death.