When thereB次元官网网址檚 only one ventilator but two patients who need it, how should a doctor decide who gets the chance to survive?

Medical ethicists across the country are working to help frontline workers answer weighty questions should the COVID-19 pandemic overwhelm hospitals the way it has in northern Italy and New York City.

B次元官网网址淭hese are not decisions we want to make,B次元官网网址� said Dr. Timothy Christie, who convenes an ethics committee that gives advice on pandemic response policy in New Brunswick.

B次元官网网址淭he planning that people are doing right now, theyB次元官网网址檙e doing the best to make it so we donB次元官网网址檛 end up there.B次元官网网址�

On Wednesday, chief public health officer Dr. Theresa Tam warned that CanadaB次元官网网址檚 health-care system could be deluged in each of OttawaB次元官网网址檚 pandemic scenarios. The system is not designed to deal with a surge of COVID-19 cases, which could mean facing difficult decisions about how to allocate sparse resources, she said.

Since the novel coronavirus was first confirmed in Canada, officials in several provinces have been developing guides so that doctors donB次元官网网址檛 feel alone in making life and death decisions.

British ColumbiaB次元官网网址檚 ethical framework builds on work started during the H1N1 epidemic and Ebola crisis. It addresses specific ethical questions on everything from distributing personal protective equipment and ventilators to B次元官网网址渄ecision making about who will get scarce treatment if that comes to pass,B次元官网网址� Dr. Bonnie Henry, the provincial health officer, said last week.

B次元官网网址淣o single individual physician or clinician will have to make that decision on their own.B次元官网网址�

In Ontario, officials have announced the formation of an B次元官网网址渆thics tableB次元官网网址� led by the University of TorontoB次元官网网址檚 joint centre for bioethics.

Alberta is working on a framework too.

B次元官网网址淭he focus will be on ensuring as many patients as possible receive the care they need,B次元官网网址� Tom McMillan, a spokesman with Alberta Health, said in an email.

In New Brunswick, clinicians will be given a principle to help them make decisions based on their expertise.

ChristieB次元官网网址檚 committee is recommending a fundamental shift in the underlying principle that doctors use to make treatment decisions if there arenB次元官网网址檛 enough hospital beds and ventilators.

B次元官网网址淚n cases where resources are limited, we would allocate the resources to people for whom we think will have the best outcome,B次元官网网址� said Christie, who is also regional director of ethics services for the Horizon Health Network, the provinceB次元官网网址檚 anglophone health authority.

B次元官网网址淭hatB次元官网网址檚 fundamentally different than the way weB次元官网网址檇 do it in normal circumstances.B次元官网网址�

Under normal circumstances, Christie said doctors ask patients what their goals are. A patient with terminal cancer might wish to spend one last Christmas with his family, and treatment plans can be adjusted to help reach that goal.

COVID-19 could create a scenario where using a ventilator to keep someone alive for an extra few months comes at the expense of another personB次元官网网址檚 life, he said.

The challenge is determining how you define outcomes when comparing patients.

B次元官网网址淭hereB次元官网网址檚 a lot of debate about how you define the best outcome. Some people would say itB次元官网网址檚 the amount of life you could live,B次元官网网址� Christie said. In other words, choosing to save the younger of two patients.

B次元官网网址淲e reject that approach,B次元官网网址� Christie said.

A 20-year-old and a 55-year-old both have B次元官网网址漵ignificantB次元官网网址� amounts of life left, so the difference between them is not morally relevant, he said.

Age isnB次元官网网址檛 the only factor being debated by the New Brunswick committee as it considers how to avoid discriminating against someone who develops COVID-19 after all ventilators are already in use.

Rather than stockpiling ventilators in anticipation of future cases, Christie said they are advising that a new patient be assessed against those already being ventilated. If the new patient has a good chance of surviving, doctors could ethically end the treatment for another patient who isnB次元官网网址檛 responding, he said.

But an ethical framework wonB次元官网网址檛 help doctors who have to decide between two patients with nearly identical outcomes.

B次元官网网址淚n that circumstance you have an arbitrary decision. ItB次元官网网址檚 going to be tragic, itB次元官网网址檚 going to be heartbreaking and itB次元官网网址檚 going to be arbitrary B次元官网网址� and thereB次元官网网址檚 no ethical principle that all of a sudden can make it better,B次元官网网址� Christie said. B次元官网网址淭hatB次元官网网址檚 no oneB次元官网网址檚 fault.B次元官网网址�

Amy Smart, The Canadian Press

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