Who Gets The Ventilator?

The coronavirus pandemic is causing a serious reexamination of our lives, including our priorities. At times the need for medical supplies has become so acute we’ve been forced to deal with some very uncomfortable questions.

For example, if the curve isn’t flattened and the hospitals are overwhelmed, who gets priority treatment? Should it be the elderly, because they are more vulnerable? Or the young, because they are more likely to survive?

Should the highest priority be the health-care workers themselves, so they can save more of us? How about a health researcher who is studying the outbreak? Or should we not even try to establish priorities, but simply go with the egalitarian first-come, first-served?

If the worst happens and you have to ration care, which criteria do you use to decide? Do you concentrate on saving the most lives, or the most life years? Medical ethicists often talk about “quality-adjusted life years” (QALY, https://www.physio-pedia.com/Quality-Adjusted_Life_Year).  Basically, QALY tries to determine how many extra years of life of reasonable quality a person might gain from a treatment. If your highest priority is saving lives, concentrate on the elderly. But how much more life expectancy do they have? Conversely, if you think society would be better off saving the young, start calculating QALY and see what the numbers tell you. And are there any other factors, like value to society, that should be considered?

If this topic interests you, it can be explored in greater detail through “Who Gets the Ventilator?”, Episode 413 on the Freakonomics website (https://freakonomics.com/podcast/covid-19-ventilators/). The program is available in both podcast and transcript form.

By the way, should we be teaching establishing priorities in medical schools so we’re ready for next time?

The challenges of modern life!

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