Too much sensitivity can kill

Alabama withdrew its guidelines for ventilator triage after the Department of Health and Human Services found that the state had discriminated against the elderly and people with disabilities.

Office for Civil Rights director Roger Severino said, "Persons with disabilities have equal worth and dignity and should not be deprioritized for health care based on a supposedly lower 'quality of life' compared to persons without disabilities.  Older Americans in Alabama can take solace knowing that their state will not impose blunt age cutoffs for ventilator allocation if, God forbid, there is a shortage."

The guidelines proposed by Alabama would not take effect unless there were in fact a shortage.  When resources are limited, the recipients must be prioritized.  In the military — remember M*A*S*H with Radar shouting, "Incoming!" — this triage is carried out by the most senior surgeon.  Everybody know how it works and accepts it.  The elderly, the unhealthy, and the moribund must take a backseat to the young and fit in equally dire need.

Triage is the process of determining the priority of patients' treatments based on the severity of their condition or likelihood of recovery with and without treatment.  This rations patient treatment efficiently when resources are insufficient for all to be treated immediately, influencing the order and priority of emergency treatment, emergency transport, or transport destination for the patient.

There are three categories of patient:

- Those who are likely to live, regardless of what care they receive.
- Those who are unlikely to live, regardless of what care they receive.
- Those for whom immediate care can make the difference.

Top priority is given to those who would survive if given immediate medical care but would die without it.  Categories may be subdivided.

The corollary is that when resources are, or can be made, adequate, triage is not necessary.

This lack of discrimination on the part of HHS is not merely stupid, not just wrong.  It is a mistake.  I trust that Alabama, in the worst crisis, will do the right thing.

(Note: The author is around 80, with a not insignificant medical history.)

Jim Whiting, M.D., C.M., three years of military service.