As ventilators, beds, and doctors began to run out during Italy's COVID-19 pandemic, the inevitable appeared: stories of Italian hospitals rationing care according to who had the best chance of survival, and for how long. The same rationing may take place in American hospitals.
A major problem in those calculations, reports the Center for Public Integrity, is that half of U.S. states have policies in place that give less priority to people with disabilities such as Down syndrome, and those standards are now rightly outraging the disabled and disability rights advocates.
The most chilling finding: "Policies in six states — Connecticut, Florida, Indiana, Kansas, Minnesota and New York — say hospitals should consider taking ventilators away from patients who rely on them in daily life if others need them more, a practice advocates say would discourage people with disabilities from even seeking treatment for COVID-19."
What? It will absolutely lead to those patients refusing to be hospitalized. Going to the hospital with your own personal ventilator in a state with policies suggesting doctors seize it to save someone more worthy sounds absolutely insane. How is that even possible?
Other standards are troubling as well. Five states call out cystic fibrosis patients as not recommended for ventilators, but "there's no evidence that cystic fibrosis patients can't fully recover" from this virus. And policies that attempt to weigh each patient's remaining lifespan to decide who is more worthy of care may do so based on raw statistics of each underlying condition, with little consideration for that patient's likely different odds.
The mere thought of rationing care to begin with is horrible, of course, which is one of the many, many reasons efforts to "flatten the curve" have been so urgent: to avoid peaks that will overwhelm medical systems, and will result in precisely those decisions having to be made. The suggestion of CPI's reports is that the standards and their methods of implementation have been put in place because individual doctors do not want to be forced into those decisions themselves; it seems impossible, in the midst of a crisis, that they would not be.
Even in parts of the nation with no shortage of beds, the inherent inequality in standards of care, resources available, and long-term community health is producing widely disproportionate results. In an overwhelmed system, the implications are ... horrifying. That is the only word I can think of.