Pa. finalizes plan for deciding who gets life-saving care if hospitals overwhelmed

By David Wenner

The performance of a new coronavirus vaccine is tested at the Wistar Institute in Philadelphia, but the finished product remains in production. In the meantime, doctors on the front lines of the coronavirus fight are looking to drugs that are already approved for treating other diseases. (Monica Herndon/The Philadelphia Inquirer/TNS)

The Pennsylvania Department of Health on Monday afternoon put out a finalized set of guidelines hospitals can use to make hard decisions such as who gets an intensive care bed or ventilator if there aren’t enough for everyone.

The latest version, dated April 12, comes about a week after people with disabilities objected to an earlier version, saying they worried their disability would count against them.

It continues to use a points-based system for deciding which patients have highest priority. The process would apply to all patients brought to the hospital during the health emergency, not just those sick with COVID-19.

It retains a goal of making decisions that benefit the greatest number of patients. It also seeks to maximize “life years,” which favors younger patients. However, rather than basing decisions on exact state, the system uses groupings which correspond to life stages, such as 12-40 and 41-60.

In the event of ties, the system favors people directly involved in addressing the crisis and preserving social order. In addition to doctors and nurses, that involves anyone in the chain of the response, such as first-responders and people who disinfect hospital rooms.

The guidelines state a goal that “no one is denied care based on stereotypes, assessments of quality of life, or judgments about a person’s ‘worth’ based on the presence or absence of disabilities or other factors.”

Gov. Tom Wolf and Secretary of Health Dr. Rachel Levine had previously vowed that no one would have less of a priority because of factors such as disability, race, sexual orientation or financial status.

Still, people with disabilities and their advocates continued to voice concerns, saying their life experiences are filled with evidence of deep-rooted biases toward them.

They said a more fair system would disregard any condition that existed before the person was stricken with COVID-19.

The state health department began working on the guidelines last year, expecting it to take about 18 months, but COVID-19 has speeded up the process.

While the guidelines are officially regarded as “interim,” the state is advising hospitals to use them in the event of a surge of COVID-19 patients and scarce medical resources.

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