How Do You Choose Who Gets a Ventilator?

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How Do You Choose Who Gets a Ventilator?
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The issue of who gets a ventilator and who has to wait has become urgent as doctors, hospitals, and states decide how to ration the life-saving equipment should they become overwhelmed with COVID-19 patients.

There are no uniform national guidelines on the subject. But some states, hospital systems, and individual hospitals have made their own policies, says bioethicist Paul Wolpe, PhD, director of the Center for Ethics at Emory University in Atlanta.

“There are guidelines for triage, and triage was developed in wartime,” he says. “The fundamental principle that should be used is if there aren’t enough ventilators, which will probably be the case sometime soon, is to give the resource to the people who would be most likely to die if they did not get the ventilator and would be most likely to live if they got one.”

New York state guidelines give patients a SOFA score, which measures the number of organs that have failed, he says. The acronym stands for “sequential organ failure assessment.” As Klitzman says, “[Doctors] don’t have a conflict of interest where they feel, ‘Gee, this is my patient, Mrs. Jones, and I’m going to do everything I can for Mrs. Jones.’”

There are two reasons for such policies. First is reciprocity. “This is what we owe them for putting themselves in harm’s way so profoundly,” Wolpe says.

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