[CitizensTruth] ARTICLE -

[Walterb306 at cs.com]

All,

Preparations underway.  Yahoo.com lets out plans.  Can we connect the dots?

Beverley

Who should MDs let die in a pandemic? Report offers answers 

http://news.yahoo.com/s/ap/20080505/ap_on_he_me/pandemic_rationing_care_3&
printer=1;_ylt=AhZI6I5z4FNzC2UvxVysWA9a24cA

By LINDSEY TANNER, AP Medical WriterMon 
May 5, 7:35 AM ET 



Doctors know some patients needing lifesaving care won't get it in a flu 
pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let 
die.

Now, an influential group of physicians has drafted a grimly specific list of 
recommendations for which patients wouldn't be treated. They include the very 
elderly, seriously hurt trauma victims, severely burned patients and those 
with severe dementia.
The suggested list was compiled by a task force whose members come from 
prestigious universities, medical groups, the military and government agencies. 
They include the Department of Homeland Security, the Centers for Disease Control 
and Prevention and the Department of Health and Human Services.

The proposed guidelines are designed to be a blueprint for hospitals "so that 
everybody will be thinking in the same way" when pandemic flu or another 
widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical 
care specialist in San Diego and lead writer of the task force report.

The idea is to try to make sure that scarce resources — including 
ventilators, medicine and doctors and nurses — are used in a uniform, objective way, task 
force members said.
Their recommendations appear in a report appearing Monday in the May edition 
of Chest, the medical journal of the American College of Chest Physicians.

"If a mass casualty critical care event were to occur tomorrow, many people 
with clinical conditions that are survivable under usual health care system 
conditions may have to forgo life-sustaining interventions owing to deficiencies 
in supply or staffing," the report states.
To prepare, hospitals should designate a triage team with the Godlike task of 
deciding who will and who won't get lifesaving care, the task force wrote. 
Those out of luck are the people at high risk of death and a slim chance of 
long-term survival. But the recommendations get much more specific, and include:

_People older than 85.
_Those with severe trauma, which could include critical injuries from car 
crashes and shootings.
_Severely burned patients older than 60.
_Those with severe mental impairment, which could include advanced 
Alzheimer's disease.
_Those with a severe chronic disease, such as advanced heart failure, lung 
disease or poorly controlled diabetes.
Dr. Kevin Yeskey, director of the preparedness and emergency operations 
office at the Department of Health and Human Services, was on the task force. He 
said the report would be among many the agency reviews as part of preparedness 
efforts.

Public health law expert Lawrence Gostin of Georgetown University called the 
report an important initiative but also "a political minefield and a legal 
minefield."

The recommendations would probably violate federal laws against age 
discrimination and disability discrimination, said Gostin, who was not on the task 
force.

If followed to a tee, such rules could exclude care for the poorest, most 
disadvantaged citizens who suffer disproportionately from chronic disease and 
disability, he said. While health care rationing will be necessary in a mass 
disaster, "there are some real ethical concerns here."

James Bentley, a senior vice president at American Hospital Association, said 
the report will give guidance to hospitals in shaping their own preparedness 
plans even if they don't follow all the suggestions. 

He said the proposals resemble a battlefield approach in which limited health 
care resources are reserved for those most likely to survive. 
Bentley said it's not the first time this type of approach has been 
recommended for a catastrophic pandemic, but that "this is the most detailed one I have 
seen from a professional group." 

While the notion of rationing health care is unpleasant, the report could 
help the public understand that it will be necessary, Bentley said. 

Devereaux said compiling the list "was emotionally difficult for everyone." 

That's partly because members believe it's just a matter of time before such 
a health care disaster hits, she said. 

"You never know," Devereaux said. "SARS took a lot of folks by surprise. We 
didn't even know it existed." 
___ 
On the Net: 
CHEST: http://www.chestjournal.org 
U.S. Govt.: http://www.pandemicflu.gov

   
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