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

Triage is not easy, it is horrible to HAVE to do. It’s not done with an ethics professor guiding (that’s good, b/c the patient would die before his/her prolegomena was half done!)

The other issue that is being ignored here is the COLLATERAL damage in the health system as well - the OTHER critical cases that get brought into a stressed, short-on-supplies, infectious hospital - these ALSO are getting less-than-optimal care (which is what the American health system delivers anyway, but…)


Yeah, I had a heart attack in Dec of 18, and I wonder how the care I got would have been different in today’s Italy or New York.


And Trump is a literal raging narcissist. He is raging at imagined slights to his fragile ego while people die.
1722 reported deaths as of this minute.
WHILE he says yesterday (actual transcript follows)

Donald Trump: ([28:22]
I think they should be appreciative. Because you know what? When they’re not appreciative to me, they’re not appreciative to the Army Corps, they’re not appreciative to FEMA, it’s not right. These people are incredible. They’re working 24 hours a day. I mean, Mike Pence, I don’t think he sleeps anymore. These are people that should be appreciated. He calls all the governors. I tell him… I mean, I’m a different type of person. I say, “Mike, don’t call the Governor of Washington. You’re wasting your time with him. Don’t call the woman in Michigan.” It doesn’t make any difference what happens-

Speaker 5:
You don’t want him to call the Governor of Washington?

Donald Trump: ([28:54]
You know what I’m say? If they don’t treat you right, I don’t call. He’s a different type of person. He’ll call quietly anyway, okay? But he’s done a great job. He should be appreciated for the job he’s done.


And it’s not even his narcissism that is going to kill the most people. Rather it is his distrust of experts and reflexive contraryness. He behaves as if the best way to seem decisive is to contradict expertise and do the opposite. That in turn feeds into his narcissism because he trusts that his “gut” is better than all the experts in the world.


You’re family making that determination isn’t the same thing as the STATE making that determination… That’s just flat out fascism, when the state tells you who deserves to live and to die. The individuals or the families need to make those choices, not the state. In this case, medical professionals who are on the front lines should be empowered to make these decisions, not the state.


Guess Roy Moore is on his own.

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Let’s seize them first.

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Ability to pay. Alabama is a “right to live” state, meaning you have the right to live … if you can afford it boy.

I’m sorry for your loss.

That is a valid distinction and there are things we don’t want the state to do. But if family members can make that distinction but it’s hard to see how a state making that decision constitutes fascism. The state issues guidelines about life and death all the time. For example, a state funds a university’s research into one disease instead of another. We also have state run hospitals that triage people and during floods, governments have to decide to open levees or floodgates. We’re just seeing these decisions at a large scale because of the situation is so bad.


Because people who died while receiving care lasted for like three or four weeks on a ventilator before dying. Since there aren’t enough ventilators, meanwhile one, maybe even two, people who could have survived came into the hospital and were denied that ventilator and died. So you have two or three people dead instead of one. It’s just cold, hard math at play here. That’s what happens when you don’t have the resources.

In the hard-hit parts of Italy, at this point everyone over a certain age is being denied a ventilator, because the odds are better for someone younger (who also needs it). The US is going to be worse because our infection curve is steeper and we have fewer medical resources per capita, and we seem to be seeing more serious cases with young people.

It’s worse than that because there’s no guarantee that being put on a ventilator means you survive. What was happening in China and Italy was someone was put on a ventilator and surviving for a month before finally dying. So the conundrum is whether to have resources being monopolized by someone who probably isn’t going to survive anyways, especially given that someone with a better prognosis might not even need the ventilator for that full length of time. The awful calculus at play is just about maximizing the number of people who survive, not making judgements about how many years they have left.

Normally, with triage, you have a bunch of patients come in at once, and decisions are made as to who has the better prognosis, who is likely to live long enough to receive the limited life-saving care. But this is so much worse - you have a person who is already being treated, who is already on a ventilator, but now someone else gets admitted with a better chance of survival and that first person gets taken off the ventilator and left to die.

I mean, it’s already demonstrably the case - evidence clearly shows that black people are denied care, their health concerns are ignored, etc., leading to substantially worse outcomes even when adjusted for the health, wealth and education, etc. of the patient. For decades, the medical establishment actively attacked anyone who did studies that showed this, but now the evidence is so overwhelming, they can’t deny it. Yet it still remains. (And leaves aside racist myths about imagined biological differences between white and black people that have been codified into medical textbooks and training.)

When the health-care system is racist, you have racist outcomes. Codifying standards would cause racism to be codified into the standards. (One of those racist myths that would directly come into play in this situation is that black people don’t have the same lung capacity as white people, a myth that originated in the 18th century and is currently codified into the programming of spirometers.)


Not the issue. Note that the person you responded to said that their grandmother had to be restrained or she would attack her caregivers. That is, to put it mildly, a serious liability as far as her chances of survival are concerned. Never mind “value of life.” Under “normal” conditions a wealthy society with resources to spare might well choose to give her all the care and other resources that she could use [1]. That’s the environment that has shaped our thinking on this.

It’s just that that the current environment is not that environment.

In Italy, at the peak of their epidemic mortality, the deaths from all causes rose in tandem from the deaths from COVID-19 – but the “all causes” rise was roughly four times that of the identified disease rate. Details, right now, are not clear but one contributor is that the resources going to intensive care of COVID patients reduced the care available to other purposes such as “routine” cardiac, stroke, trauma, etc. to the tune of 3:1

“Heroic but futile” efforts to save one person may well result in the deaths of three or more others. That is what triage protocols attempt to prevent. It’s horrible that advanced, wealthy societies are being put in that situation. Maybe we’ll learn from this and find ways to prevent recurrence but right now that’s where we are. Right now there are no good solutions; we’re stuck with “least bad.” That may well mean that an Alzheimer’s patient who not only can’t cooperate but is actively combative due to inability to understand what’s happening, may be passed over for care in favor of two or more others with at least as good a chance given care.

It sucks. Absolutely sucks. But … “least bad” is the best we can hope for at present.

[1] The question of whether she would want them if she could comprehend the question etc. is a different matter. My advanced directive solves that question, and is being supplemented with an order explicitly deprioritizing ICU care for me in the current situation. But, as you point out, that’s my choice.


Not down with the idea of sending the mentally disabled to their death, but “persistent vegetative state” is another matter for me. If I could write down some ‘pull the plug’ rules for my next of kin, this would be one of them. I would hate the idea that vegetative me would get preference in a triage situation, because of my good physical health and relatively young age for example, over a sentient person who would then fail that same triage because she’s 30 years older than me and has diabetes.



Donald: “Eric, you better cancel that rally in Alabama I asked you to run.”


The original article is highly emotional and relatively fact-free, I would hesitate to make any judgements based on it.

I’m a social worker in a large medical organization. In my area we aren’t at a triage point yet. We are prepping for it however, going over the protocols etc. If/when it comes, I am going to be part of the triage process. While I won’t be making the decision if that happens, I will be called on to provide things like capacity assessments, among other things. I assure you they will have nothing to do with valuating the worth of people’s lives or future quality of life or anything like that. Future life expectancy has little to do with it-- triage is NOT the same thing as end of life care decision making. The decisions will be about the amount of care and support a patient will need to benefit from treatment, that’s it. Triage is a relatively mechanical, value free process, about the efficient allocation of insufficient resources to maximize the number of people not dying, in a situation where a lot of people are going to die.

Please Please Please stay the fuck home and away from other people, so I don’t have to do this.


I thank you, and she thanks you.

The Lord works in mysterious ways.

I just finished filling out my ‘Advance Directive.’ It states how and when to pull the plug under various circumstances, and who should make this decision if I cannot make the decision myself. A copy has been sent to my doctors.


Or what it might be going forward with a serious pre existing condition.