Who Will Live and Who will Die? Some US Hospitals Weigh Withholding Care to Ebola Patients

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Top Tier Gear USA

Health care workers display protective gear, which hospital staff would wear to protect them from an Ebola virus infection, inside an isolation room as part of a media tour of the emergency department of Bellevue Hospital in Manhattan

Photo credit: Reuters

The Ebola crisis is forcing the American healthcare system to consider the previously unthinkable: withholding some medical interventions because they are too dangerous to doctors and nurses and unlikely to help a patient.

US hospitals have over the years come under criticism for undertaking measures that prolong dying rather than improve patients’ quality of life. But the care of the first Ebola patient diagnosed in the United States, who received dialysis and intubation and infected two nurses caring for him, is spurring hospitals and medical associations to develop the first guidelines for what can reasonably be done and what should be withheld.

Officials from at least three hospital systems interviewed by Reuters said they were considering whether to withhold individual procedures or leave it up to individual doctors to determine whether an intervention would be performed. Ethics experts say they are also fielding more calls from doctors asking what their professional obligations are to patients if healthcare workers could be at risk.

US health officials meanwhile are trying to establish a network of about 20 hospitals nationwide that would be fully equipped to handle all aspects of Ebola care. Their concern is that poorly trained or poorly equipped hospitals that perform invasive procedures will expose staff to bodily fluids of a patient when they are most infectious. The US Centers for Disease Control and Prevention is working with kidney specialists on clinical guidelines for delivering dialysis to Ebola patients. The recommendations could come as early as this week.

The possibility of withholding care represents a departure from the “do everything” philosophy in most American hospitals and a return to a view that held sway a century ago, when doctors were at greater risk of becoming infected by treating dying patients.

“This is another example of how this 21st century viral threat has pulled us back into the 19th century,” said medical historian Dr. Howard Markel of the University of Michigan.

Some ethicists and physicians take issue with the shift. Because the world has almost no experience treating Ebola patients in state-of-the-art facilities rather than the rudimentary ones in Africa, there are no reliable data on when someone truly is beyond help, whether dialysis can make the difference between life and death, or even whether cardiopulmonary resuscitation (CPR) can be done safely with proper protective equipment and protocols.

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  • Free People

    Hah! Everybody laughed at Sarah Palin when she talked about the ‘Death Panels’ in Obolacare, but here it is! Create a pandemic, bring it in to the US, and withhold care. Agenda 21 population CONtrol.

    • guest

      There have always been death panels, they just weren’t made public. It’s well know within the medical community that patients between the age of 65-70 are not aggressively treated as those younger. Some of these patients would like longer with more aggressive and expensive care but someone makes the decision to to treat the patient as if they were 35. So they leave the planet a little sooner. I had a friend who was terminal with breast cancer that had spread to her spine and was in terrible pain. Nothing they gave her worked. One evening we were told they were sending her home the next day because she was not at the point of death. Her husband was reluctant to take her home because they could not control her pain. He couldn’t take time off work to care for her, couldn’t not go to work because her treatment over the years had been expensive so he told the doctors he didn’t know what to do. I leave the hospital, 6 hours later he calls and tells me she has died. Not unexpected but what? He eluded she was given help and that there would be no autopsy and cremation was schedule for the next day. Someone made the decision to give her a little too much pain medication. I have family members that are doctors and nurses and decisions like this have been going on for decades. It’s just unspoken.

      • notation

        The word is “alluded,” you dim bulb, and it isn’t even the right word in that context. Why are you people so god-damn dumb?

    • notation

      If you were any dumber, we’d have to use weed-killer on you.

      You are a fvcking idiot.