Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma in patient care, you vote, and then we present an expert's judgment.
Last week, you voted on the ethics of taking an elderly man with COVID-19 off a ventilator in a triage situation. Here are the results from almost 4,000 votes:
Would you prioritize the care of healthier and younger patients and shift the ventilator from the elderly man to patients with a higher probability of recovering?
Yes: 55.65%
No: 44.35%
Would you change your decision if the elderly patient had been in intensive care for a non-COVID-19-related illness?
Yes: 21.89%
No: 78.11%
Would you prioritize the older man over college students who had likely been infected during spring break trips?
Yes: 28.88%
No: 71.12%
And now bioethics scholar Gregory Dolin, MD, JD, weighs in:
Generally speaking, under traditional common law, one is under no obligation to render aid to anyone. ( has, of course, changed that in certain situations, but the basic principle remains.) However, once a person begins to render aid, he or she must continue to do so. That does not mean that extraordinary or futile actions must be taken; rather, it means that one cannot stop aiding simply because he no longer wants to or thinks that a more "worthy" activity needs to be attended to. Thus, there is a difference between DNR or even withdrawal of futile care and withdrawing care simply because the doctor thinks a newly arrived patient is more "worthy" of it.
Of course, doctors always prioritize and ration scarce resources. But usually, such actions occur not on the basis of any "worthiness" or doctor's evaluation of someone else's "quality of life," but on the severity of the illness.
Under these principles, I would tend to think that withdrawal of care on the basis that it is better to save a younger rather than an older patient is inappropriate and potentially opens up doctors and hospitals to massive tort liability.
, is associate professor of law and co-director, Center for Medicine and Law at the University of Baltimore, where he also studies biopharmaceutical patent law. His work includes a number of scholarly articles, presentations, amicus briefs, and congressional testimony.
And check out some of our past Ethics Consult cases: Harvest a Dead Man's Sperm?, Let Suicidal Cancer Patient Be Duped Into Taking Meds?, and Euthanize Resistant Dementia Patient?