This commentary is by Elayne Clift, who writes about women, politics and social change from Saxtons River.
A mother watches her 7-year-old child die in excruciating pain from a ruptured appendix in their car, waiting to get into the emergency room.
A family member sees a 44-year-old relative succumb to a heart attack, waiting for a bed in the cardiac care unit.
A woman suffering from high blood pressure during pregnancy awaits admission to the hospital, even though she’s in premature labor.
These actual examples underscore the reality of people unable to obtain crucial health care because of a crisis that has been exacerbated by people who refuse to be vaccinated against Covid-19. Not only are extremely ill patients dying in parking lots, but hospitals are also suffering shortages of beds, staff and equipment, especially in intensive care units, and they’re flying some patients out of state for care, while leaving others who need urgent care literally out in the cold.
It’s an unimaginable, horrific scene to contemplate.
A friend of the man waiting for cardiac care put it this way. “Car accidents happen. Heart attacks happen. Trauma happens and there may not be care for you in the hospital if we can’t do something to get this under control.”
The fact is, it’s been getting harder to control.
It is not just a terrifying experience for people waiting for care. It’s also difficult to imagine what it must be like for exhausted doctors, nurses and other health care professionals. What must it be like as a nurse holding the hand of a young patient who might be succumbing to Covid, or setting up a Zoom call so someone on a ventilator can wheeze out a farewell to loved ones?
Consider the emotional toll it takes to be on a team that must declare one patient worthy of trying to save and another not quite so worthy. It’s a deeply depressing situation to ask anyone to endure.
The burnout rate among health workers skyrocketed initially in the Covid pandemic. Now, with the Delta variant, a significant number of nurses are leaving or considering leaving the field. A report issued by The Washington Post/Kaiser Family Foundation in June “found that 26% of health care workers in hospitals are angry and 29% have considered leaving the medical field. These are the warning signs of a smoldering epidemic of burnout among front-line medical professionals.”
In the midst of the current crisis, the idea of rationing health care — which several hospitals have been forced to do or to contemplate by triaging who will live and who will die — begs for attention. Rationing care, often applied during wartime, should not mean that people of any age living with a pandemic must have their lives cut short because others refuse to comply with lifesaving mandates or masking requirements and end up occupying all available beds.
We may never know exactly how many people in this country died from Covid-19 but many compounding variables must be considered, from lack of health insurance to increased vulnerability to poverty. It’s likely that deaths from rationed care will likely not be listed among them.
In 2010, an Institute of Medicine committee defined the term “crisis standards of care” as “a substantial change in usual health care operations and the level of care it is possible to deliver which is made necessary by a pervasive (e.g., pandemic) or catastrophic (e.g., earthquake) disaster. This change in the level of care delivered is justified by specific circumstances and is formally declared by a state government, in recognition that crisis operations will be in effect for a sustained period. The formal declaration that crisis standards of care are in operation enables specific legal/regulatory powers and protections for health care providers in the necessary tasks of allocating and using scarce medical resources and implementing alternative care facility operations.”
I wonder if the crafters of that statement were thinking about rationed care during a pandemic resulting in numerous tragic deaths because some people behaved irresponsibly when they wrote that definition, given that they emphasized that “in order to ensure that patients receive the best possible care in a catastrophic event, the nation needs a robust system to guide the public, health care professionals and institutions, and governmental entities at all levels.”
To achieve that objective, the committee cited the importance of “fairness — standards that are … recognized as fair by all those affected by them,” and “equitable processes — processes and procedures for ensuring the decisions and implementation of standards are made equitably.”
The Hippocratic Oath, the basis for medical ethics, no longer required of graduating medical students by many medical schools, does not actually contain the phrase “First, do no harm.” Nevertheless, medical students, some of whom write their own oaths, as well as doctors and other health care providers, are deeply dedicated to their commitment to providing compassionate care and healing practices for all those in need.
That’s why I believe 20 percent of hospital beds, ICU or otherwise, should be allocated to unvaccinated patients suffering from Covid, while 80 percent of all beds and resources be available to anyone requiring care at any level in order that their lives or health not be held hostage to those who have made choices that are not only deeply selfish but dramatically dangerous.
That seems more “fair and equitable” to me than people having to die in hospital parking lots. It also might just be the way to “get this under control.”
