(Visiting a Chinese medical school, February, 2006)On Sunday, I caught a few minutes of a Rush Limbaugh program being replayed from one day last week. (I'm not sure which one.) Demagogue and ideologue that he is, Rush was citing a passage from a Florida hospital's H1N1 contingency plan as evidence that the Obama administration's health care reforms will include "death panels." Apparently, in the event that mass casualties overwhelm this hospital, and they lack adequate facilities and equipment to care for everyone, they plan to concentrate on those with the best chance of survival.
The charge would be laughable, were it not for the fact that so many people seem to idolize and believe Rush. This Florida hospital's mass casualty plan merely reflects the standard operating procedure in military and civilian emergency rooms alike. It is called "triage."
Battlefield aid stations routinely have to practice triage. When they're faced with more casualties than the available doctors, corpsmen, and nurses can handle, they first help the seriously wounded people with reasonable chances of survival. Those with little or no chance of survival wait, as do the lightly wounded. Otherwise, two soldiers or Marines may die instead of the one who is likely to die no matter what the doctors do. It's a tough calculus, to be sure, but it is also the only moral thing to do.
Civilian emergency rooms usually don't have to make such tough calls, but they routinely practice triage nevertheless. If you arrive with a minor cut requiring a few stitches, and a man with chest pains arrives a half hour after you do, guess who will be seen first?
In all fairness, though, what really bothered Rush was a statement indicating that, if there are not enough ventilators to go around, the hospital may have to take patients with little or no chance of survival off their ventilators. Rush, of course, sees this as a slippery slope toward "death panels." He's wrong. The hospital was merely positing the worst-case scenario, one that may never come to pass. But, if it should, and you were an attending physician at that hospital, would you take a chance on losing two patients instead of one? The hospital in question clearly intends to save as many people as they can, not to select people for euthanasia. --EFP