Flu Nightmare: In Severe Pandemic, Officials Ponder Disconnecting Ventilators From Some Patients

[rmp yellow]

Source: Pro Publica

With scant public input, state and federal officials are pushing ahead with plans that -- during a severe flu outbreak -- would deny use of scarce ventilators by some patients to assure they would be available for patients judged to benefit the most from them.

The plans have been drawn up to give doctors specific guidelines for extreme circumstances, and they include procedures under which patients who weren’t improving would be removed from life support with or without permission of their families.

The plans are designed to go into effect if the U.S. were struck by a severe flu pandemic comparable to the 1918 outbreak that killed an estimated 50 million people worldwide. State and federal health officials have concluded that such a pandemic would sicken far more people needing ventilators than could be treated by the available supplies.

Many of the draft guidelines, including those drawn up by the Veterans Health Administration, are based in part on a draft plan New York officials posted on a state web site two years ago and subsequently published in an academic journal. The New York protocol, which is still being finalized, also calls for hospitals to withhold ventilators from patients with serious chronic conditions such as kidney failure, cancers that have spread and have a poor prognosis, or "severe, irreversible neurological" conditions that are likely to be deadly.

Read more: http://www.propublica.org/article/flu-nightmare-officials-ponder-disconnecting-ventilators-from-some-pat-923

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Why not buy a whole bunch of ventilators now instead of complaining of the lack of ventilators in the future?

[HereSince1628]

1. Well, shit, WE are just citizens. What do we have to say in the weighty

decisions of the physician/hospital administrator demi-gods.

Don't you know THEY ARE THE FINAL DEATH PANEL????????????????????????????????????????????????????????????????????

[bbinacan]

6. These guidlelines were

drawn up by government entities.

[HereSince1628]

8. No fuckin shit? So THAT makes them RIGHT. Join the RW GOP

that rationale works perfectly over there.

[Name removed]

19. Deleted sub-thread

Sub-thread removed by moderator. Click here to review the message board rules.

[bbinacan]

2. That is just fucked up.

I agree with the OP.

"Why not buy a whole bunch of ventilators now instead of complaining of the lack of ventilators in the future?"

Btw, welcome to DU.:toast:

[pnwmom]

36. And how do you distribute those ventilators? How do you predict with precision

how many new ventilators each hospital needs? And how many extra beds should be squeezed in? And how many nurses should be rushed through nursing school?

It is quite possible, no matter what plans we make or actions we take in the next few months, that many of our hospitals could be strained well beyond capacity. Then what? Decisions will have to be made.

[nebenaube]

116. Simple...

And the med equipment companies will love it. At less than $3k each, each person can be put on bi-level positive airway pressure support. Respironics calls their product Bipap. That name is trademarked but similiar devices are referred to as bi-level positive airway pressure support. The device provides a form of constant positive airway pressure that is used to treat sleep apnea. It can be set at different pressures for inspiration and expiration respectively as well as adjusted for spontaneous or timed pressure support. Basically it is a cheap portable non-invasive ventilator.

[pnwmom]

123. How many do you buy when you don't know how big the pandemic will be?

How do you decide how to distribute them? How do you make sure you have enough beds in the hospitals, and rooms, and doctors and nurses to staff them? When the major pandemic that could happen is something we haven't seen since the development of modern medicine?

You really think this is simple?

[primavera]

167. No, of course it's not that simple

Nothing in life is. But that doesn't mean that the situation couldn't be improved upon. This is exactly the kind of problem public health professionals are trained to address. As you say, there's no way to know in advance exactly how many ventilators will be needed where, but plans can be made in advance to rapidly transport ventilators to where they are needed most, to work with government, nongovernment, private, and international organizations to be able to maximize the number of ventilators that can be delivered on short notice in the event of a crisis, and so on. I'm not a public health professional, so I don't know even a fraction of the possible remedies that they might be able to provide to address such a crisis. I do however know that, in the US, we spend less than 5% of our total health budget on public health, even though over 50% of premature mortalities in this country are preventable and lie within the province of public health. In most post Stone Age counties, public health is understood to be a vital component of health care. Unfortunately, in the US, our "individuals first, public welfare dead last" ideology keeps funding for public health down to the barest minimum. Public health benefits populations, not specific individuals, and to us that sounds suspiciously like being asked to fork over some of our hard-earned dollars to support welfare programs for deadbeats, and we don't abide by any of that commie pinko nonsense in this country. Far better that whole populations suffer than that individuals be asked to cough up so much as a thin dime to help anyone else. So public health remains a marginalized, underfunded, understaffed community occupying a back office in a forgotten warehouse somewhere in the political wasteland, and then we wonder why it is that, when a crisis comes along, we're so ill equipped to handle it. Wake up people, you get what you pay for and, when you don't pay for anything, you don't get anything.

[MadMaddie]

173. Then the planning should be underway for tent cities

like during the 1918 Pandemic.

My biggest concern is people are not going to the dr at the beginning of their symptoms because they don't have health insurance so by the time they get to the Emergency room that are in pretty serious condition.

[Mojorabbit]

166. It takes skilled people to run those ventilators

with constant monitoring 24/7. There are not near enough people with the education to do it. This has been the plan for years. Triage who is most savable.

[pnwmom]

3. It's impossible to guess how many ventilators might be needed, or how to

distribute them.

But I think withholding them -- in case of shortage -- from people with conditions that are already terminal, such as advanced Alzheimer's or terminal cancer, would be a reasonable approach to take.

[HereSince1628]

7. Yes, ABSOLUTELY Kill the elderly! KILL the UNPRODUCTIVES!

THAT ___IS___ the capitalist way.

[rmp yellow]

14. I think they'd target those who wouldn't improve. Not the elderly

That's what I read.

[HereSince1628]

22. For all the above....It's great to be so young that you have a clear vision

of the value of even one day of life.

Stop and think about this. Triage isn't really fair. Rich people WILL get care, hell, they'll even get the organs of the poorer people who don't get care.

Who is to say what life has more to offer? REALLY? THINK ABOUT A REALLY AIR-TIGHT ARGUMENT that says a "terminally ill" person doesn't have a valuable day to live.

Triage in a capitalistic, ageist society isn't about fair, its about return on investment==profit.

Why rail against mandates and co-ops when you accept THIS?

[pnwmom]

39. Get a grip. n/t

[Chemisse]

150. If there was a shortage in a hospital and your child lay there dying,

In need of a ventilator, I think you would be pretty pissed if a terminal cancer patient was using it instead.

Hell, if I was a terminal cancer patient I would be hard pressed to defend my right to use it when others could be saved.

These are just the decisions that have to be made.

[aquart]

152. Ask a friend to slap you. Now.

What a ridiculous bout of hysteria.

[pnwmom]

15. That is not what I said, as you know. If someone is already dying from a

disease that has a predictable disease path -- as I said, advanced Alzheimer's or terminal cancer -- they would benefit less from extending their dying than a basically healthy person would from using the ventilator.

One of my sister's extended family spent the last five years of her life dying in a nursing home, all of that time in a coma, fed by tubes. She was resuscitated five times over the years, rushed to the emergency room, and eventually back to the nursing home. She finally died at the age of 105. (Yes, she entered the coma and the nursing home at the age of 100.)

Is that the path you think we should all take? Keep all of us alive as long as possible, no matter how much suffering or how poor the quality of our lives?

[virgogal]

24. God,that's awful. I'm old and have talked to my family, my doctor,and had the legal papers

done so that I don't have to go through that.

[pnwmom]

42. The problem was that the woman's grandchildren

(she had outlived her children) couldn't all agree on a DNR order. It IS painful to let a loved one go, no matter what the circumstances. But that doesn't mean that what was done to her was right, IMO.

[virgogal]

76. Awful situation to be in. I had a DNR on my mom,who died at

91 but her last five years were just awful (dementia).

[dflprincess]

90. It is hard to let go

but there comes a time to let nature take its course. How sad that any of the grandchildren could think this is what their grandma would have wanted. This story certainly stresses how important it is to make your wishes known in advance, preferably written, but at least tell everyone.

[pnwmom]

124. It was always hard for me to imagine that this is what the woman would have wanted.

She was very religious; not afraid of dying. But she had basically raised the grandchildren, since her daughter died when they were young and their father couldn't deal with them. That probably made it even harder for them to let her go. They couldn't stop their own mother from dying, but they could hang on to their grandmother long past the time most of us would have let go.

[tammywammy]

93. And that's why my grandfather has a living will and DNR

He's had friends on tubes for long periods of time before they died. He flat out told me "when it's my time, it's my time, I don't want to live like that."

[mamaleah]

151. If the patient or family has a DNR, fine. Otherwise it is not yours or the governements decision

who lives and who dies.

[bbinacan]

10. What?

You don't even try? Good grief.

[pnwmom]

25. Who said that? Why do people love to make these leaps?

No matter what is done, there is bound to be a discrepancy in some places over issues of supply and demand -- there already is, every day in emergency rooms across the country. It's called "triage" -- deciding who gets priority with limited resources -- the big one being doctors' time.

So, even after we plan as well as we can in a short period of time for a pandemic, there will still be these issues, such as the question of available ventilators, to resolve.

[Ruby the Liberal]

4. TERRA!!

Sorry, not biting.

This seems more OpEd than breaking news.

Have a good evening.

[sicksicksick_N_tired]

5. Scare,...tactics? Anyone?

No thanks! I have tired of it, myself.

[kestrel91316]

9. It's called triage. It's how limited medical resources are allocated during emergencies.

If we just buy unlimited ventilators, then if things get really bad we will simply run out of trained people to monitor all of them.

If things get THAT bad, some people are just gonna have to die. Sort of like during wars.

[HereSince1628]

11. Yes, Triage with age- and future promise of productivity discrimination

Who the fuck is to say that an older person should die?

THIS IS ABSO-FUCKING-LUTELY why the over 50 folks are suspicious of federal progams in health

[pnwmom]

17. Do you think all older people have advanced Alzheimers? They don't.

And they don't have other terminal neurological conditions or terminal cancer, either.

This isn't about the elderly. It's about people who are already dying, and whether they need the same sort of medical measures to extend their dying that could be used to bring other people back to health.

[Warpy]

20. You've completely misunderstood the concept

Triage is based on who is likely to survive. That is often completely independent of age or work capability.

There are 40 year olds who are the medical equivalent of a train wreck. There are 80 year olds who live independently, take good care of themselves, and might have only the one physical problem.

During normal times, we have the equipment to try to save both of them. During an emergency, tough decisions have to be made about allocating resources.

Those decisions never take into account who the person is. They only take into account whether or not heroics are likely to work.

[HereSince1628]

23. Actually, as a former public health officer I haven't missed a thing

I've watched this sort of shitty plan being developed.

It ALWAYS requires devaluing one life over another.

Practicality, practicality. Shit. This IS NOT about practicality. It's about profits and the prospect of society benefiting from one life over another.

Just because under 30's haven't had an exposure to H1N1 flu isn't a reason to kill everyone over 74 who has outlived their contribution to society.

[pnwmom]

30. I assume you think the Terry Schiavos in the country should all be given

ventilators, too, no matter how many other people are in need.

Sorry, but I don't agree. Few people would, I think.

[HereSince1628]

32. Your making unwarranted assumptions, and it's more personal opinion

based on nothing more than a few bytes in the ether.

[pnwmom]

46. So what is your personal opinion? If there was a shortage, should a Terry Schiavo

with insurance be given a ventilator instead of the 24 year old unemployed uninsured mother you spoke of?

I'm beginning to see where you're coming from.

[HereSince1628]

51. Shiavo is really a cross between a red-herring and a straw-man argument

I'm not going to engage it beyond saying that it should NOT BE THE CHOICE OF A FOR-PROFIT HEALTH-CARE PROVIDER.

[pnwmom]

80. Wrong. Terry Schiavo was a real human being, and there are real human

beings like her all over the country.

[HereSince1628]

84. Yes, but trying to exploit her case as a lever in an argument

is a pretty good example of a red herring.

[pnwmom]

117. Why? Her kind of case is EXACTLY what the OP is about. She was a person

who was dying, for several years, in an irreversible process. It would have made no sense to keep her on a ventilator in the case of a shortage.

[Regret My New Name]

134. Answering your question turthfully will make heads explode.

[Warpy]

31. Perhaps if you'd ever worked in hands on health care

you'd understand it a bit better.

The truth is that such decisions are made every day, although they don't go as far as to do terminal weaning from ventilators without family permission. That would happen in a real public health crisis, though, and it would be done according to patient viability, not age.

This is a lie the right wing is pushing, more of the "death panel for seniors" bullshit.

I expected better on DU.

[HereSince1628]

38. Oh, I HAVE NO DOUBT that such decisions are made everyday

I'm just saying that mostly it is about profit and providing healthcare from those who have money or those who socitey sees as "more valuable" to the future.

Triage is not fair. It might be a practical solution to logisitical/financial problems, but is sure as shit isn't fair.

Logan's Run

[pnwmom]

55. Of course triage is fair. When I come to the hospital with a child

with a hurt foot, as opposed to an adult with a heart attack, I expect to go to the back of the line. With limited resources -- and there are always limits in ANY system -- priorities have to be made.

What ISN'T fair is letting some people cut in line on the basis of connections or wealth, rather than medical condition.

[HereSince1628]

59. You are so FULL OF IT, give me something other than a strawman

[pnwmom]

64. Are you sober? You're not making sense. n/t

[HereSince1628]

65. And you are making arguments with foregone conclusions

Are you smoking something that I should be smoking?

[pnwmom]

71. I'm asking questions that you refuse to answer. Terry Schiavo, remember her?

You still haven't answered. If resources like ventilators become scarce, should people like her be just as entitled to them as the 24 year old unemployed mother you earlier referred to?

[HereSince1628]

78. Terry Shiavo is a red herring. I get it that you don't get that.

You just want to get the most productivity back from those people who you decide society should invest in.

[Hugabear]

131. How exactly is it red herring?

It's very relevant to the argument, because we're talking about deciding who gets care and who doesn't. How would you handle an individual like Shiavo, who was brain dead with absolutely no prospects for recovery? How would you handle an H1N1 patient who had severe complications, and no real prospect for improvement?

[Electric Monk]

66. Guess what? You and everybody you know are going to die

of something, someday.

Get a grip.

[HereSince1628]

70. Yes, so I should die SOONER???????????????????

That is such a non sequitur, it exposes a certain faith in irrationality.

OF FUCKING COURSE IT IS BETTER FOR ME TO DIE THAN YOU OR SOMEONE YOU CARE ABOUT!!!!!!!!!!!!!!!!!!!!!!!!

THAT is the nature of "doing what it takes"

[Electric Monk]

83. I sense panic. DON'T PANIC!

I had h1n1 about a month ago. I felt terrible, with nausea, diarrhea, fever, cough, random muscle aches, the whole enchilada. I stayed in bed 3 days (when I wasn't in the washroom), lost 10 pounds, then started to feel better again on day 4. It's a flu.


It's not the 1918 flu.


Tens of thousands of people die of regular flu every year. The concept of triage is nearly as old as the concept of modern medical care.

[HereSince1628]

88. I had H1N1 two weeks ago, I just got the confirmation today, I'm not panicked

about H1N1. I got it even though I had the swine flu shot while in the military back in the mid 70's.

What bothers me is that is seems people think that younger people DESERVE to live more than OLD people. That's ageist bullshit, popular I know, but ageist bullshit nonetheless.

[tammywammy]

94. It's not young vs old

It's people that are terminal or have less of a chance to make it, versus those that CAN make it. Age isn't a factor, it's the condition of the person that matters.

[HereSince1628]

96. Sure it is. I'm sure that makes you more comfortable.

So, just go with it.

[tammywammy]

97. I think you need to look up what triage is

This is a common practice and not something new.

[HereSince1628]

100. Hey, I know ALL about triage. Because it is an old concept

doesn't make it right or logical to apply in ALL circumstances.

Maybe you should look up logical fallacies?

[tammywammy]

105. So then what's your solution?

This is only being suggested in an emergency, what is YOUR solution that would help everyone during this particular type of emergency?

[HereSince1628]

110. People who have been committed to life-support should be allowed

to remain on life support, until that violates their desire, or the desire of a guardian recognized by the law.

What sort of deciever is a medical system that renigs on the support it promised?

In my mind, it's first come, first served. At least until things become in short supply. At that point, denying a person certain technological care because there are no additional facilities for care is understandable. And I expect in that case, people with the money that makes healthcare possible will get whatever limited care is available.

[tammywammy]

112. This is about extreme circumstances in the first place.

They are talking about when things become in short supply during a severe pandemic.

[HereSince1628]

119. They are talking about AFTER a person has been triaged once

(a decision put them on life support) and then reversing the triage decisions because someone else has the potential for greater contribution to society.

It's pretty much a simple, but most a most profound, promissary astoppment.

[pnwmom]

128. First come, first served? That would mean the person with the broken arm

gets treatment in an emergency room before the person having a possible stroke. Doesn't make much sense to me.

[Hugabear]

130. Exactly. I can just see people dying in emergency rooms while nurses tend to runny noses

That seems to be what the poster would prefer. First come first serve, to hell with triage. How dare doctors make emergency medical decisions.

[HereSince1628]

137. Yes, while old people on ventilators are kicked off to make them available

for people who have more to contribute to society.

That's just very sorry reasoning.

[Hugabear]

129. As usual, you provide nothing whatsoever of any substance

You just can't seem to let go of this RW-induced "death squad" hysteria, and now you're actively pushing the notion that old people are going to be killed simply because they're old. That is such complete and utter bullshit.

Triage is all about deciding can and cannot be saved. Yes, sometimes that person is an elderly person, but not always. I love how you conveniently danced around the question about Terry Shiavo, since it didn't fit into your preconceived hysteria, but that is the reality. NOT your "every old person is going to die" meme.

[HereSince1628]

141. Triage has nothing to do with REMOVING people from life support

Go ahead and check it out.

Look up fucking TRIAGE in ANY dictionary.

When an instituition places a person on life support they make an utterly solemn promise to that person. A promise that should only be voided at the will of the patient or the decision of a guardian.

[pnwmom]

126. If it was between me and a healthy child, I think the child deserves

a chance at life. And I'm middle-aged.

It's not being ageist. It's about not being selfish.

[Regret My New Name]

135. Pointing out that resources are not unlimited is not a strawman.

[HereSince1628]

138. Kicking someone off life-support for someone with 'more to offer' aint fuckn triage

[Regret My New Name]

171. So how would you handle a sitation...

in which you have someone come in who has a great chance of a full recovery if they get the equipment/medicine/whatever, but the resources needed are being used by patients who have little chance of recovery? It seems the pragmatic solution is to move those resources to wherever they can do the most good. I suppose I might be missing something, aye?

[Warpy]

68. Life isn't a movie

and triage is done based on viability.

[HereSince1628]

74. True, triage is done based on the best interests of someone

and it is really difficult to argue on anything other than the notion of greater future value to people who don't have their plug pulled.

[gateley]

34. What would be your solution? nt

[Hugabear]

127. Way to exagerate and totally miss the fucking point

Nobody said anything about "killing everyone over 74 who has outlived their contribution to society" - nice strawman attempt, and pure RW talking point bullshit.

It's about medical professionals making tough decisions during an extreme emergency - which is EXACTLY normally happens. You obviously know nothing about the concept of triage, either that or you're deliberately buying into and spreading RW panic.

[jwirr]

118. Triage has been used in war time so it is not a new thing. When there

is a crisis the medical personnel help those that CAN be helped first.

[HereSince1628]

140. Removing people from life-support isn't part of triage.

Check it out. Triage is deciding to treat immediately, to treat later, or to not treat and let the bastards die.

Someone who has been placed on a ventilator was made a solemn commitment. Pulling the fucking plug for a person with more to give society is not ANY part of triage.

[Electric Monk]

143. "Someone who has been placed on a ventilator was made a solemn commitment." Indefinitely?

Forever and ever, amen? :shrug:

[dflprincess]

27. You're being hysterical

I am over 50, I am not suspicious of federal health programs most of my friends are around my age, most support a single payer system for everyone. What some people "over 50" have gotten suspicious about is that Medicare is going to be taken away, not government health plans (at least those who understand Medicare is a government health plan)

As said in another post, this is triage. Do you really think it is unreasonable for a hospital to make a decision, based on prognosis, about who gets the ventilator? There is nothing in the guidelines that says it will be based on age - the decisions will be made based on the patient's condition.

Last spring one of my friends died. For 28 years she laid in a Terri Shiavo like state, kept alive by a feeding tube until her parents finally had it removed. Are you saying it would make sense to you to put someone in that condition on ventilator if she got H1N1? And if someone in that condition were on a vent, it makes sense to you to keep them on it even if it means someone with a chance of recovery and a normal life doesn't get one?

I suppose it could get bad enough that age might be a factor. Painful as it is for me to say this, would it make more sense to put my mother who is 85 and in pretty good health on a vent (though she already has a directive that says no machines so it wouldn't happen) or my niece who has 3 young children?

[HereSince1628]

28. You're calling names, too. So in an irrational presentation who the fuck wins?

[dflprincess]

47. I was making an observation, not calling names

and I'm not being irrational. Triage happens. It could happen after a tornado or a traffic accident. It happens everytime a person goes to the ER and someone decides how urgent a case is or if someone else needs to be seen first. It is nothing new.

Maybe it's because of all those air raid drills we had in elementary school to practice what to do when the USSR bombed us that I just can't be bothered worrying about something that may never happend.

[HereSince1628]

53. Sure you were

[pnwmom]

56. Once again, you refuse to answer perfectly reasonable questions. n/t

[HereSince1628]

62. So you say.

[LeftyMom]

29. That's how triage always works in a time of scarcity.

Seniors ALREADY GET federal health programs. Jebus.

[HereSince1628]

113. NO it is NOT

People are regularly triaged. But when they are placed on life-support, such as ventilators, it is because they meet criteria. Typically they aren't removed from ventilators because someone else needs the ventilator.

[LeftyMom]

132. "Typically" does not equal what happens in a goddamned emergency.

You can stomp your foot and type in caps all you want, but in a disaster situation such as a pandemic when not everybody can get treatment due to lack of space, equipment or trained personnel, efforts focus on people with a chance of healthy survival and the worst cases get comfort measures at best.

[HereSince1628]

136. A pandemic of a flu that can't be distinguished from a mild cold

Really.

What this has really revealled is an awfluuly ageist mentality.

It's based on the notion that old people who are using medical facilities should be kicked out of those facilities to make room for people who have more to offer society.

Wow. If THAT is the mindset of the base of democratic party, count me absolutely out of it.

[LeftyMom]

139. Oh ffs. You fail thinking forever. Bye.

:hi:

[HereSince1628]

142. Bye bye

[aquart]

153. Okay, now you've made me laugh.

And I don't think you were ever in, actually.

[kestrel91316]

33. Speak for yourself. I am over 50 and am NOT suspicious of federal health

programs.

In a dire respiratory epidemic, difficult decisions would have to be made about allocation of precious resources. What's YOUR solution?

A ventilator for every single American, lol???

[HereSince1628]

45. Yes, that's your opinion. I appreciate your holding it, but

Your opinion doesn't make a case.

[NickB79]

87. What do you think doctors currently do with organ transplants? nt

[HereSince1628]

92. I think that, mostly, the organ transplants to people with access to healthcare

That usually means people with economic means.

Unless their is equity between people and universal healthcare, the poor will always donate more tissues to those with economic means than they recieve in return.

It's one of those fucked-up ponzi schemes of capitalism.

[JDPriestly]

149. Doctors will make these decisions. They won't make them based on age and

potential productivity. That's not the way they think. They will make their decisions based on health factors. Kidney disease is not necessarily advanced only in the elderly.

The problem with this flu, as I understand it, is that it is deadly to relatively young people. It is, apparently, a respiratory ailment. That is why the respirators will be in such demand.

Doctors are expecting an epidemic. We don't remember what that is like.

[bbinacan]

12. And welcome

to govvie run health? Is that what you're saying? Shit happens?

[kestrel91316]

37. I don't want family members and loud whiners making medical decisions in

a crisis. I want medical workers and those in the know about resources to make the decisions.

What the hell does this have to do with "government-run health care"?????

You anti-government types crack me up. And BTW this is DEMOCRATIC Underground, so take your antigovernment paranoia elsewhere.

[bbinacan]

52. I think it is

YOU that needs to take the paranoia elsewhere.

[gateley]

13. Seems reasonable -- if I'm going to die anyway and my ventilator could help

someone else live, I say give it to them.

[HereSince1628]

16. The problem with that is that it is solipsistic, why should what you would want

to do be applied to everyone?

I am most certain that the families of alzheimer's patients wouldn't be nearly so willing to see their loved ones sacrificed so that some snivling, unemployed/underemployed emarried and uninsrued 24 year old mother could be provided access to a ventilator
rather than their own family member.

[pnwmom]

21. I think you should talk to the families of more patients with advanced Alzheimer's.

You would probably learn something.

Most of them would give the 24 year old mother the ventilator, without question, as painful as it would be. Living for years with an advanced Alzheimer's patient is its own kind of hell.

[HereSince1628]

26. Do family members REALLY speak of the interest of their

Alzheimer's victims? Or are they pursuaded by the costs of management to pull the plug?

I've watched this play out in several dozen families while recording information in a research study. It really isn't as cut and dry as you want to suggest.

[Bluenorthwest]

40. How's this?

My Mother has advanced Alzheimer's, she has no money so the State pays her costs. I and the rest of her family would know at once that she'd want the 24 year old, especially a snivelling one, to have the ventilator if it came to that. No question at all about it.

[HereSince1628]

41. One instance does not a CASE make.

I appereciate what your family may want to have done. But that isn't generalizable.

[dflprincess]

86. My mom and her sisters are all in their 80s

and, thankfully, in pretty good shape. No signs of dementia though they have their share of physical problems, none that are fatal, just "wearing out".

They all have advance directives that say no machines under any circumstances. My friends all seem to have the same written or verbal instructions from their parents. One thing many of them seemed to find amusing was the "pull the plug on Grandma" meme the wingnuts have been floating. All of these people have made it clear that if the only thing standing between them and death is a plug, they want it pulled. Most of them feel if they've reached that point, odds are there isn't much hope for a meaningful recovery. (For that matter, 20 years ago my grandmothers had the same attitude).

One thing I've noticed as people age into their 80s is that they do not seem to have the fear of death that we have when we're younger. In fact, like my grandparents, most the elderly people I know now have expressed the hope that they'll "go" before they can no longer live on their own or before they develop dementia.

I think you would find that most elderly people would say a younger person should get the venilator and the chance of survival.

[pnwmom]

148. I agree. The elderly people I know all have a much greater fear of developing

Alzheimers or having a debilitating stroke that prevents them from leading independent lives than they do of a quick death. In fact, my mother gave me the medical power of attorney, rather than one of my sisters, because she has more confidence that I understand and support her wishes in this regard.

[pnwmom]

147. You're generalizing from your experience. Others are generalizing from their own.n/t

[gateley]

54. My father had Parkinson's dementia -- symptoms almost identical to

Alzheimer's. He had great insurance and gobs of money. I insisted on taking care of him at home (with help, as he had the $$$ to pay for it). Had to feed him through a tube in his stomach. He couldn't get out of bed, had to be bathed, rolled over, etc. Finally got pneumonia. After he died I felt badly that I had kept him around too long, just because I didn't want to lose him.

So in my case, I was not persuaded by the costs of management to pull the plug, so apparently you missed me while doing your research study.

[HereSince1628]

61. Sorry for your guilt, but it is just more personal anecdote.

[pnwmom]

69. And it is just as valuable as your opinion.

Probably more so, because it is rooted in real experience.

[HereSince1628]

82. But I'm not stating an opinion other than reflection on the nature

of the argument itself.

Triage is inherently dedicated to the interest of society, mostly stated as MOST LIKELY TO PROVIDE A RETURN ON INVESTMENT, as determined by a highly educated and ethically moderated death panel

[gateley]

79. Yes, but I'm fairly certain I'm not the only one who experienced this and

feels this way, so maybe I'm a fact in somebody's survey.

[HereSince1628]

95. Well, you wouldn't necessarily know it if you were

States regularly extract information from patient records without patient's foreknowledge.

[pnwmom]

63. I know many families through

my mother in law, who is in her 90's and in very good health. But most of her peers are not. And the families dealing with advanced Alzheimers are suffering -- and have been, in most cases, for years.

[pitohui]

163. thank you pnwmom

i wonder if this person has a heart and a brain or they are just all hysteria

the cruelty i've seen done to my older relatives w. alzheimer's beggars belief, you wouldn't make a dog go on living like that, and oddly enough i believe if they were actually poor, they wouldn't have been forced to suffer for so many years

rich people w. alzheimer's are just too tempting a feast for every vulture there is, for them to be allowed to go a quiet death

one of my relatives, as a young girl, she was whispered about in the 60s for having many millions, at a time when that was a lot of money, i envied her then, but i sure as hell didn't envy the TWENTY FUCKING YEARS she was kept alive in a home while everyone in shooting range profited from her inability to understand what was happening around her

they only let this poor woman die when virtually every penny had disappeared into somebody's pocket

any homeless bum on the street, who still remembered how to walk and talk, was better off than she was

horrible, horrible, horrible thing to do to a human being that once had a brain and presumably still had the ability to feel and to suffer but no ability to understand WHY

if only the flu or pneumonia did come in time to spare her some of this awful torture...it would have been a blessing FOR HER, although too bad so sad for all the thieves who profited from hanging around to pick her pockets!


there is HUGE MONEY being made in america by denying a good death to people, HUGE MONEY and hysterics are either profiting from it (have investments in this industry, astro-turf) or they are just being used because face it it's just too easy and tempting to use a hysteric

[gateley]

43. Okay, I'll reword it. If I, gateley, am terminally ill and my ventilator can be used

to keep a person alive who isn't terminally ill, then s/he can have mine. Even if it's a snivling, unemployed/underemployed emarried and uninsured 24 year old mother. My post said I would give him/her MINE -- I'm not asking anybody else to share my viewpoint.

If I got to the point of being terminally ill anyway, chances are that the medical community has taken more steps than I would have liked to keep me alive anyway (I'm thinking of people with cancer, for example, who are pumped full of chemotherapy until the last minute.)

[HereSince1628]

48. Again, a personal choice is not an argument for general policy

Surely this isn't that hard to grasp.

[gateley]

72. Surely it's not hard to grasp that I am only speaking for myself - how much

more clear do I need to be?

If that becomes the policy, then I accept it.

[HereSince1628]

99. It becomes a policy because an authority imposes it on you

and you will accept it?

Wow!

Just WOW!

[gateley]

120. Yeah. WOW! What are you planning on doing to see that it doesn't happen? nt

[dflprincess]

103. So tell, us, what do you think the policy should be?

Save the 90 year old terminal cancer patient and let the "24 year old unemployed, single mother die"?

If she's a single mother because her husband was killed in Iraq, would that make her more worthy in your eyes?

[HereSince1628]

111. see #110

[pnwmom]

18. Me, too. n/t

[gateley]

75. I think it's just you and me, pnwmom. Hopefully this policy if it actually

becomes a policy, won't need to be implemented.

[Name removed]

81. Deleted message

Message removed by moderator. Click here to review the message board rules.

[LeftyMom]

133. Again?

I need to bring my ignore list flowers or something to show my gratitude.

[elocs]

35. Anybody see anything wrong with getting people scared shitless and worked up

before anything has happened? Then they try and compare this with the flu pandemic of 1918 which killed millions and at the same time try to claim, "we're not trying to scare anyone". Butter wouldn't melt in their mouths.

[murray hill farm]

44. The plan is reasonable.

It is not about age at all, but as an oldie pushing 70, it would also make sense to me to save youth first if the situation came down to it. This is just a very sensible plan during such a pandemic event.

[HereSince1628]

58. That is ONLY your personal opinion

Although you may be "right" you can't expect that because you state it that makes it right.

If you really appreciate the nature of the "truth content" of your statement, you certainly shouldn't accept that it makes it right for anyone but you.

[murray hill farm]

85. Funny...

I thought I was expressing my personal opinion! But...now that you brought it up....your "right" may also not be right because you state it to be right and your "right" may not only not be right, YOU shouldn't expect that your right is right for everyone else. Just saying!

[HereSince1628]

109. Nope

I'm not stating a "right."

I think it is absolutely fine to die. I also think it is absolutely fine for family members of other people to have other opinions.

I think it is tyranny for a society to kill someone because their "potential for societal contribution" is diminished. I'm suggesting that it is inherently unfair to take a person who has been placed on life-support OFF-LIFE SUPPORT simply because a second person is seen by society as having more to offer back to "the system."

Triage is fine at the point of acute care. My gripe is with the idea that after a person is committed to life-support, their continued access to life-support that was offered should be halted because someone else who needs life support arguably has greater potential for future contributions.

[murray hill farm]

115. And you, of course....

are very much intitled to your own opinion...and i greatly respect your right to have it.

[HereSince1628]

121. I'm arguing that the argument supporting death panels

for people on life-support is flawed.

That is not an opinion, but an argument.

Good or bad, although it is my argument, it is subject to logical and evidentiary rebuttal. Opinions on the otherhand are unassailable and free from rebuttal.

[excess_3]

49. who are the voting members of these death panels?

how did they get elected?

[MidwestTransplant]

50. This is an Obama plan to socilize medicine, kill old people and set up prison camps for Glen Beck

listeners.

[stray cat]

57. There are not enough of a certain type of ventilator for the estimates of those who need them.

just like transplantations - not enough organs and in the short term not enough ventilators - people die and you can't make organs or ventilators overnight

[rmp yellow]

67. Perhaps people would be willing to pay a tax in order to raise funds for the ventilatorsr

That's a possibility.

[pnwmom]

73. It's not just ventilators. That would be too easy.

It's medication, hospital beds, hospital rooms, nurses, doctors -- our medical system could be strained well beyond capacity in the event of a major pandemic. Choices will have to be made.

[Liberty Belle]

60. God forbid they could just buy more ventilators?

The RW's penny-pinching is killing people - spread the word.

[pnwmom]

77. That wouldn't solve the problem. Our whole medical system could be

strained beyond capacity in the event of a major pandemic.

[hedgehog]

91. I was talking about a similar problem with my husband this morning.

How do you staff a hospital even in normal times? Say you have a 20 bed maternity unit serving 2 or 3 counties. Some days, 10 women deliver, and you're over staffed. What happens the day 15 women show up, and you already have 10 women in labor? The same question applies to other specialties - cardiac care, stroke care, etc. Elective surgeries can be scheduled, but some things happen on their own schedule.

But you're absolutely right. Hospitals beds are pared down to the minimum needed. There is no way that we are prepared for massive illnesses. In the photos from 1918 -1919, you see tents full of people, mostly soldiers and sailors. I suspect most civilians lived or died at home in those days. There really wasn't much to be done at the hospitals back then.

As noted above, even if we built millions of ventilators, where would we get the nurses to monitor them?


Also as noted above - we already do apply this type of triage every day with organ donations. The organs go where they will do the most good. Someone dying of lung cancer will not be given a new liver.

[tammywammy]

89. It's triage

And not something to be surprised about. Even if you had an unlimited supply of ventilators, there's not an endless supply of medication or beds or even enough doctors/nurses to take care of everyone. Something has to give in the system.

[HereSince1628]

98. So it has a name, and it has a purpose, that makes it RIGHT?

That is a pretty facile appeal to pragmatism.

We just accept that? OR do we get more medication, more beds, more doctors/nurses, etc.

After all, SOMETHING has to GIVE in the SYSTEM. I don;t see how your argument is better than seeking GREATER access to GREATER numbers of people????????????????????????

WOuldn't that make GROWTH that could potentially STIMULATE the economy?

[Posteritatis]

101. Let's just have the magical unicorn fairies bestow infinite medical resources on everyone!

There isn't a medical environment on the planet that has any choice other than "just accepting that" when the casualty count gets high enough.

This is not an outrage-worthy situation.

[tammywammy]

104. Okay, so what do they do?

Build more hospitals, get more ventilators/IV tubes/bandages/supplies, get more doctors, get more nurses, get more medicine, etc. And how long would that take?

This isn't a new concept, it's pretty basic, there are limited resources and in an emergency triage is used throughout the country to make sure resources go to those that are more likely to survive than those that are in a futile position already. Greater access is good, but at the same time you have to be realistic and see that as a goal THAT would take YEARS to happen. So yes, that's a good goal to try and achieve, but what do you suggest happen in the mean time?

[dflprincess]

106. Just for curiousity's sake,

how do you plan to get more doctors and nurses in time for a pandemic that could hit this fall?

[HereSince1628]

114. That is a change of subject.

The issue I object to is that it's ok to allow people to be removed from life-support (that they were placed on because they met specific criteria warranting that treatment) because other, more deserving, people need the ventilator.

Making a life-support commitment is just bout the most solemn promise I think anyone can make. To renig on that promise because someone with more money, or more promise to contribute to society is a wretched breach. I object to that. Removal of life support should be at the will of the patient or the person they designated as a guardian.

[dflprincess]

122. Go back and read your own post

you're the one who brought up "getting more doctors/nurses".

[HereSince1628]

125. Yes, as a general alternative to arguing to put people to death because health workers are in short

supply, getting more workers seems as valid an optin as choosing to kill people because resources are in short supply. And it is free of all the ethical baggage.

I am aware that increasing healthcare workers presents its own logistical and time constaints. I am also aware that equipment acquisition has lead times to delivery.

[truthisfreedom]

144. Since both of those are true, reality has to be addressed. No amount of shrillness will

change that.

[thelordofhell]

102. Would you rather have a government plan for disaster contingencies....

or would you like to have what happened during Katrina to occur on a national scale?

[McCamy Taylor]

107. Is this real or made up by the "death panel" people? Hospitals prioritize all the time.

They decide who gets surgery first etc. Why would the government have to tell them how to do it?

[tammywammy]

108. I wonder that as well

I would assume every hospital already has a plan on hand that would deal with this. :shrug:

[cherish44]

145. Call me cynical but this is realism to me

The ones that will get the ventilators in a catastrophic pandemic will be the ones with the $$$. End of story.

[progressivebydesign]

146. it's already a pandemic.. do you mean EPIDEMIC? n/t

[rmp yellow]

154. Not sure. What's the difference?

I'm not too sure of the difference between the two terms. Maybe it's a pandemic but not a "severe pandemic," as described by the article.

[triguy46]

169. "Pandemic" has no relation to severity:

Pandemic means its a) a new novel virus not seen; b) effective human to human transmission; c)widespread incidence.

What is of concern is severity: the death rate per 1000 cases. So far this one is very low, like 1968.

[Blandocyte]

155. I hope the filthy rich are stocking up on ventilators

It'd be a shame to let mere peasants have access to such equipment.

:sarcasm:

[DallasNE]

156. Who Will Be The First Republican

To use this as an example of rationing that the Obama health care plan has already caused. What we will more likely see is price gouging by the private drug companies to those with the means to pay.

[Robb]

157. I guess I'm a little baffled as to how this is "news."

1- Who the heck is "Pro Publica," and

2- Did none of them read draft pandemic plans prepared all across the country 2-3 years ago?

I'll educate myself on the first question. The second is however glaring.

[rmp yellow]

158. You can begin your education here

The story about Blue Dog rep. Mike Ross and his shady deals with the health industry was broken by Pro Publica.

Rachel Maddow said, "Today, “Politico” published investigative reporting about Mike Ross by a reporter named Marcus Stern. He reported it for ProPublica. If you‘re looking for a possible explanation from Mike Ross‘ stance against his own party and his own constituents on health reform, consider this—in 2007, Mike Ross and his wife had a piece of property to sell. It was a pharmacy that they owned and operated in Prescott, Arkansas—a small town that‘s about 100 miles southwest of Little Rock."

http://www.msnbc.msn.com/id/32984908/ns/msnbc_tv-rachel_maddow_show/

The story was very popular here in DU: http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=385x376238

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6613729

[Robb]

159. You seem educated on Pro Publica and DU

...In the interest of transparency, do you have any affiliation with Pro Publica?

And you haven't explained why this is news, either. Anyone who read pandemic plans, even ones created in rural communities, years ago would not find anything in this report surprising -- only a touch sensational.

[rmp yellow]

161. "Anyone who read pandemic plans"

It would be interesting to know how many people bothered to go to the guideline portion of the New York or Health Dept. website to read about preparations for severe flue pandemic.

This was certainly news to me, as I had no idea this was included in the preparations. I still think the plan makes sense though. How many people were aware of these guidelines before the article was published? We have no idea. A poll would be helpful. But for now, I can speak for myself: I didn't know this before.

By the way, half your argument was based on the fact that you didn't know Pro Publica existed. And you seemed angry that someone helped you learn more about the website, since you raised the possibility that I am tied to the website, only because I like their work and I know that Maddow knows it, and you don't.

I suppose I stand to profit from the Glenn Greenwald and Greg Sargent blogs, since I like them too.

[Robb]

164. I would never argue against informing people of anything

...however, the alarmist nature of it is unfortunate. As is passing it off as news.

Thousands participated in the pandemic planning process in my county alone. Broad spectrum of community involvement. Discussion panels. Tabletop exercises. Everyone from police to veterinarians, if I recall. I am glad that you now are aware of it.

[Oak2004]

174. I read the New York plans, and was very satisfied by them

They go to great lengths to insure that triage is not based on assumptions of social worth or "quality of life" assumptions (the latter having historically been an excuse for denying care to the disabled), but that it is based strictly on medical criteria which indicate the likelihood of survival. They also insure that someone already on a ventilator will not be pulled simply because someone walking in the door after them seems more likely to survive (which, they point out, violates medical ethics).

And yes, they also describe additional purchases of ventilators and how to distribute these ventilators held in reserve across the state should they be required.

It's a good document.

[Hekate]

160. Triage is a medical concept well-known in battlefield situations

:shrug:

[pitohui]

162. there are some silly people in this world

a plan for triage is necessary or you get the monday morning quarterbacks vs. the doctors and nurses who actually cared for patients during a disease trying to accuse the people who actually got off their ass and did something of murder -- a quick revisit of hurricane katrina is all we should have to understand about that

triage if needed should be used, so that the largest number of people can be saved, if you assume the pandemic will be on the scale of a hurricane or a war (i don't assume it will but IF) then of course triage will be necessary, in the rare event that some unpredictable huge bad thing happens

we really can't afford to buy a ventilator for everyone in america in event of a highly unlikely pandemic that hits everyone at once -- oh, wait a minute

does the person who thinks we should buy all this unnecessary hospital equipment happen to own stock in these equipment supply companies? aha, now the faux outrage is starting to make a little more sense

btw, it's stupid and cruel to put a demented person on a ventilor when the flu has the chance to give them a peaceful death, instead of keeping them alive screaming for another five years about how nobody is feeding them and everybody is conspiring against them (because their brain is destroyed and they don't remember their own kids or how they got in the hospital) but whatever...i can see the motive for why a nursing home owner would want to keep the demented person alive forever, because those checks just keep on coming and coming from medicare, so who cares that the person is in hell w. no chance of recovery? there can indeed be no mercy where there is $$$ to be made

[Hekate]

165. amen

:thumbsup:

[triguy46]

168. This is in an extreme, e.g. 1918 pandemic

with extraordinary morbidity and mortality. Ventilators are very expensive to have sitting around, who will pay for them? Who will be around to use them? What rooms will they be in.

Use the following CDC tool to evaluate the impact of such a situation in your area. It helps if you know some details of beds, current #vents, etc.

http://www.cdc.gov/flu/tools/flusurge/

[transeo]

170. Necessary planning, that's all

The idea that there will be an infinite supply of every piece of medical equipment and every medication is unrealistic. This is just necessary planning for how to utilize resources to save the most people in the unlikely event of a shortage or supplies and care providers.

I work in a hospital emergency operations center and we are talking about this a lot. No one likes it, but the fact is if there were a pandemic of severe illness and the reach of the 1918 flu, there would not be enough health-care workers or supplies to keep up with demand. Period. Nothing can change that. There won't be enough devices for this unlikely situation. Doctors and nurses are people too. They will also get sick, further limiting the care that can be provided. Choices will have to be made. Why not have a plan in place for this?

This is like putting woman and children in the lifeboat first. It is also very hypothetical. It is not something that will be put in place just because there's an outbreak. It's worst-case scenario planning. Chill out.

[Fire_Medic_Dave]

172. We did buy bunches of them.

Many local governments did with State and Federal grant money specifically for that purpose.