Healthcare professionals confront the question of whether to treat or not to treat daily. We are just coming out of the completely specious shutdown of our state. Implicit in a pandemic is the decision of to treat or not to treat. So who will make that decision?
Will it be you, the patient? Will it be your doctor? Is the healthcare facility the decision-maker? Will it be a public health authority? Do you want it to be bureaucrats at NH HHS? Will it politicians? Who controls the death panels? Do they exist? Who is on them?
Do you know? How will those who are going to make those decisions setting priorities in decision making? What goes into the deciding how to allocate resources? How the task is undertaken determines who will live and who will die. Maybe we should care? Why is nobody talking about this?
What’s the plan?
States have something called crisis standards of care plans. Have you heard about the one that applies to you and yours? These plans determine what happens within the state in the event of a pandemic. There are three types of standards. The standards are: conventional standards, contingency standards and crisis standards of care. They pertain to access to equipment, ICU beds, etc. They extend also to things like DNR orders and how they could be administered.
At what level are these plans being made? Is it the state, the county, facility level? Are there federal requirements for these? If so what are they? Are such plans cooperative geographically, politically, or in some other way… or maybe not.
So who gets treatment under these plans? Massachusetts put out a document last month. It explicitly lays our what they would do and how. Their plan talks about lotteries to break ties. It talks about the scoring system to decide who gets access to care. After going public they have pulled back the plan and revised it for political reasons?
There are a lot of complaints about how this is going to be done. There is much discussion of their decision criterion. They use scoring systems such as sequential organ failure assessment. Massachusetts also puts other criteria on top of that system. The other criteria are things they euphemistically call life cycle considerations. Those are basically sorting by age or pre-existing condition. These are things that impact life expectancy and quality of life.
How do you appeal the decision and who to?
The states of Washington and Alabama are in litigation about their plans. When these things are implemented we may not know. The states and facilities have not committed to making them public. Since it will directly impact your probability of surviving a crisis you should have a right to know where you fit in the system.
You may think your healthcare decisions are between you and your doctor. That may, at this point, no longer be true. The DHHS federally says there is no one size fits all federal standard of care. That does not mean that they have not mandated that they be created at other levels of government. It also does not mean that there aren’t guideline, minimums, maximums and regulations. This is pretty classic accountability dodging.
But what it means is a change has been mandated. DHHS, the states and the healthcare providers have probably imposed the system on you. It means no one made inquiry of healthcare system users. Even of the existence of the change is secret. If I’m wrong please respond and let me know how irresponsible this article is.
It is absolutely known the DHHS has a rapid working group; a crisis standards of care working group. It has 12 members. DHHS has gotten a specific list of guidance from them. Specific guidance includes “clinical care committees. The goal is to remove the decision making from the clinician at the bedside. The committee will make the decisions.
Conclusion
The doctor does not decide on care. The physician input information into a system which adds up the points. The committee looks at the point scores and decides who lives and who dies. No one person responsible for the decision. There is no articulation of an appeals process … But then again “they” have not seen fit to tell us they have implemented or are considering implementing such a system.
