Member Article

The Department of Health and Human Services recently released a letter that stated that using a single ventilator for two patients should be considered “an absolute last resort.” Of course, this statement assumes that a ventilator exists in the first place, and it says nothing about how to deal with several more than two patients needing the same ventilator.

This, however, is only the tip of proverbial iceberg.

These are extraordinary times in the truest sense of the word. As the COVID-19 pandemic unfolds, there already have been and there will certainly be more issues that raise ethical concerns. As with many ethics issues, there can and will be debate about how to address these issues. Regardless of the specific issues to be addressed or the ultimate decision that are made, most people would agree that decision-making in advance is better than decision-making under duress, stress and fatigue.

To this end, providers and health planning entities are encouraged to consider the following, among other things, as soon as possible, and hopefully before they present themselves:

• How will limited resources be allocated? Of course, resources can take many forms: major medical equipment (ventilators), blood, test kits, personal protective equipment, staff, cash on hand, rent, medicine, supplies, food, and, of course, time.
• Should existing care/resources for any class of patients be withdrawn in order to provide them to others?
• Does the overall risk of the crisis justify the risks of “stretching” resources by putting individuals in care positions that would ordinarily be considered outside the scope of their license or experience?
• Should ordinary rules of defaulting to providing resuscitation (CPR) be suspended? If not, should “code” teams be limited in any way to minimize the heightened risk of exposure?
• Should advance directives that expressly prohibit the use of ventilators (and other equipment) be ignored if it appears that the presenting situation is not what the individuals had in mind while drafting their advance care plan?
• How are providers tending to the mental health of those on the front lines, those behind the scenes, and the public?
• Should drugs be used off-label in any ways that differ from the ordinary course of care?
• How much information is appropriate to share without express consent (even if relaxed HIPAA rules would allow it)?
• Should ability to pay matter? If so, how and for what?

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