MINNEAPOLIS, May 7, 2008—It's no surprise that, if a dreadful pandemic occurs, physicians will have to make life and death decisions with patients. Now, one physician group is offering a specific list of recommendations for who gets treated, and who is allowed to die.

The list of who will be allowed to die -- which includes the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia -- appears in an article published this week in Chest Journal, entitled "Definitive care for the Critically Ill During a Disaster."

The list was put together by a team whose members come from academia, medical groups (including Hennepin County Medical Center and Mayo School of Graduate Medical Education), the military and agencies including the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

"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. 

The proposed guidelines are designed for hospitals to use so that everybody will be thinking in the same way" when pandemic flu or another widespread health care disaster hits.

One purpose of the report is to ensure that scarce resources — including ventilators, medicine and doctors and nurses — are used in a standard, objective way.

To prepare, hospitals must designate a triage team whose task will be to decide who will and who won't get lifesaving care.

Of concern is the possibility that guidelines may violate exciting laws against age discrimination and disability discrimination.  They might result in preferred treatment of the rich over the poor.

While health care rationing will be necessary in a mass disaster, grave ethical concerns like these remain unresolved. 

AP report