Alabama disaster plan would deny treatment to those with "severe mental retardation"

They’re only contradictory for some measures of improvement. I suppose I should have spelled out that you need to cash out improvement as “change in chance of survival”.

EDIT: And yes, excellent point, that it has to be “per unit of resources used”. Though you often have a bunch of resources that different people need differently and you’re simultaneously short on all of them.

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You’ve got five ventilators and ten patients. You do triage - you have no choice in that, it’s inevitable. You can’t not do triage. Only question is: are you going to aim to save as many lives as possible, or aim for some other criteria? (It’s a weird definition of fascism that’s trying to save as many lives as possible).

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I go through drills like this every year. I hate the sadistic psychopaths that design them, and simultaneously am grateful for them. The debriefs frequently lead to near fist-fights. This year’s scenario was a construction scaffold collapse with a range of horrible injuries to workers and passers by. I’m still pissed off by the guy that bled out on me cuz my check wasn’t as thorough as it should have been and I triaged him too low.

The very few times I’ve had to deal with anything close to the real thing, the answers were much more obvious, and while I didn’t seize up, I didn’t perform quite as well as I had hoped I would.

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If you’d read my comments, you’d see I want to have had pre-emptive planning, which the federal government dismally planned on.

You might still end up in a triage situation, but it would not be as extreme as it’s going to be…

I know that you’ll do all you can under the circumstances and I’m sorry for that. It’s criminal that we have a government that refuses to plan ahead right now, because you’d be in a much better position. It’s also criminal that we have a political party that claims to be pro-life but clearly is not.

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I posted this a few days ago, but I’ll repost it here as it’s directly relevant:

These discussions aren’t theoretical anymore. The avalanche has already started. It is too late for the pebbles to vote.

If politicians start deciding who lives and who dies, it is too late. It is also too late if these decisions are made ad-hoc, bedside. These discussions need to happen now with qualified folks who can make these touch decisions before it’s too late.

If the trajectory goes the way the medical professionals claim, instead of how a large part of the US political machine claims, and these guidelines aren’t hammered out, IMHO, we are going to see some very, very atrocious behaviour, vs yet more heroic defiance and stepping up by bedside staff - who, as I said, should not have to be put in that position .

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Right idea, metric is slightly off. How about, “what allocation of resources will save the greatest number of people?”

I’m an OK emergency field medic. I take pride in being a pretty damn good sadistic psychopath. And who knows? That SOB who bled out on you may save someone’s life some day. It’s not terribly likely but if it happens it will justify a lot.

Train hard, fight easy. Of course the whole idea is to have you perform less than your best – that’s how your best gets better. BTW: to the lurkers, there’s always room for volunteer “victims.” It’s a serious public service, you learn a lot, and I confess it’s a hoot as well.

I know you don’t need to be told the above, but I figure some others will benefit.

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There was a good article 1-2 days ago in Ars Technica on the topic of rationed care. It was in response to this article in the New England Journal of Medicine:

https://www.nejm.org/doi/full/10.1056/NEJMsb2005114

Under ethics, the authors write:

Previous proposals for allocation of resources in pandemics and other settings of absolute scarcity, including our own prior research and analysis, converge on four fundamental values: maximizing the benefits produced by scarce resources, treating people equally, promoting and rewarding instrumental value, and giving priority to the worst off. Consensus exists that an individual person’s wealth should not determine who lives or dies. Although medical treatment in the United States outside pandemic contexts is often restricted to those able to pay, no proposal endorses ability-to-pay allocation in a pandemic.

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More like, “That’s exactly the opposite of ‘triage’.”

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The Swiss have thought this through. It is not perfect, but it is far better than Alabama’s version.


smw_2020_20229.pdf (467.1 KB)

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Such people appear not to contemplate the notion that it they live long enough, they too will be on the short end of the stick.

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This whole thing seems out of a Faulkner novel.

You’re hitting on the thing I dread telling all my friends… that in these isolated wards going after a pandemic, they aren’t gonna have a lot of time to make or help you make choices, it’s going to sound quite literally like every patient is being waterboarded, and at the most you may get SOME choices among sounding and feeling like that, being on morphine until you forget which way is up, or accepting the tube down your throat that, even done properly by the best tech/nurse on staff, may scratch or scar you.

The one saving grace for the care crew, perhaps, will be that in this pandemic/isolation mode, relatives can’t be in there second guessing everything you do.

L.A. County DHS are apparently rejecting donations of 3D printer ventilator parts. I just learned this by clicking on “Donations” on their coronavirus site.

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If you can, thank her for me. My daughter spent 42 days in a NICU. She’s 5 now and an absolute delight.

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L’etat, c’est moi.

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The answer is no one should be put in the situation of being forced to chose based on either of those facts.

Its possible to have triage guidelines that have no assessment of age, chronic illness, disability, or quality of life in the long term.

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But we will be put in that position, because the overarching instinct for administrators, from upper levels of government to local hospitals, is to avoid taking responsibility. The triage responsibilities will fall to the staff at bedside, and when this is all over I predict huge amounts of Monday morning quarterbacking, and even potential legal and financial liability for doctors and nurses who had no choice but to make the choices others refused to. It will be another case where the only choices open to us are either dead heros or live criminals.

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That is short, sweet and well thought tnrough. And terrifying. According to Darius, no battle plan survives contact with the enemy, and i am certain that will apply here as well, but at least they have a plan to start with. Puts them lightyears ahead of us.

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Can someone familiar with US law please tell me how this is even possible? In Germany, this would mean a massive constitutional crisis.

In reply to @orenwolf, I posted German news regarding the triage situation. @FGD135 provided additional links and a summary.

I would urge everyone in this topic to go there and read what they summarised, AND continues to update!

FTR: I read the statement by the national ethics commission yesterday, and it explicitly explains the implications on the rule of law in regard to a constitutional crisis if the state would be involved in the decision of a triage. (NB: Singular chosen on purpose, since a single case would be enough to trigger a massive legal and constitutional problem.)

And yes, @Mindysan33, you are absolutely right. This is fascist. It needs to be stopped under all circumstances. This is something a state must not decide.

(Further thoughts, which might distract but I want to vent.)

Germans have done this during the Nazi time, as @beschizza already mentioned. The allies in WW II put a stop to it. The Nuremberg trials were an important step to realise where it leads when the state decides who lives and who dies. The US guaranteed they were fair and public. I can’t see anyone doing this in the future we are apparently heading for.

Someone, I think @DukeTrout, called for something like the Nuremberg trials against the Trump admin because of decisions which made the pandemic worse in the US. I argued, and argue still, that the steps so far are in the realm of politics which takes into account many variables, and different scientific, legal and economic advice which might be contradictory. No one has had the “right” decisions. There still is no data on many variables considering the epidemiology of the pandemic, so I was and I am warning against “blaming” the Trump or any other admin for the direct effects of rising infections due to post-fact wrong decisions.

But this is different. If the report is factual and complete, and I am not misunderstanding something because of my limited knowledge of the legal and ethical background of the policy roughly outlined in the
ProPublica piece.

I am still a bit careful here. I see no links to the states disasters preparedness plans. I also do not know how those would be implemented, what status in law they would have etc. Most of the piece gives a “human perspective”, as we would have called this in journalists schools back when I aspired to be a science journo. But if correct, then this must be stopped. This is evil.

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I am curious to find out if they aren’t actually hammered out. It seems to me every large medical institute, such as a hospital, should have triage guidelines for pandemics and catastrophe. Such as an earthquake, tornado, hurricane, terrorist attack, etc.

I am going to reach out to at least one of the people I know in the field, such as the heart nurse, and ask if they have such guidelines where they work, and if so, does mental ability play a factor?

I absolutely agree that this should not be in the hands of politicians, but professionals in the field of healthcare. But that begs the question, if there are situations where the politician’s and professionals happen to agree, is that a “right” decision? Or maybe just a “least worst”?

I feel that this crisis is going to have a lot of examples where the decisions will be second guessed and maybe regretted and those harmed by the guidelines/decisions will have some righteous anger.

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