The Massachusetts Department of Public Health on Tuesday released guidelines for hospitals to help medical staff prepare for possible resource-rationing if the flood of coronavirus patients ever overruns the number of available ventilators, ICU beds and staff.
“The basic message of the guidelines is that the overwhelming priority is to increase our medical resources so that we have enough that everyone who needs those resources — ICU beds, ventilators— will be able to get them,” Dr. Robert Truog, director of Harvard Medical School’s Center for Bioethics, told Jim Braude on WGBH News’ Greater Boston Wednesday. “But, if we do have a shortage, it’s important that the public know that we’re not flying by the seat of our pants here.
“Over more than a decade, people have given thought to the guidelines about how to allocate those resources in a way that is fair, and equitable and non-discriminatory,” he added.
The grim preparatory document comes as the widely-cited predictive model from the Institute for Health Metrics & Evaluation anticipates that Massachusetts will be short some 3,000 beds — including about 1,500 ICU beds — at the peak of the cases.
The guidelines, which are not mandatory, advocate a point-based system that takes into account a patient’s likelihood of survival and their life expectancy after the illness, and has preferences for medical personnel and pregnant women.
Dr. Truog acknowledged that the preference for medical care workers was a point of contention within the bioethics world. The reason for the final decision, he explained, was that “some people feel that care providers need to be reassured, putting themselves at such high risk, that if they come down with this disease, that they will have access to treatment.”
The question of a patient’s likelihood of survival after beating coronavirus has also raised concerns, with some members of the public pointing out that people with certain disabilities and people of color — who already have documented lower life expectancies on average — could be on the losing end of such a point system.
When asked whether the guidelines “baked in” such disparities, Dr. Truog contended it was “just the opposite, actually.”
“I think that we’re all aware how these disparities adversely affect the care of many people in our population – and it’s going to be true in the pandemic too,” he said. “The guidelines were written specifically to minimize those to the extent possible, looking at objective criteria like … life years saved.”