Doctors, not bureaucrats, must make triage decisions

By | August 17, 2020

Using the COVID-19 pandemic as justification, bureaucrats and politicians are practicing medicine on you without a license. This violates both the Hippocratic Oath and the law, as only licensed physicians can legally practice medicine.

Citing a shortage of much-needed medications, the state of Pennsylvania is encouraging physicians to use such a “weighted lottery” to decide which patients will receive the antiviral drug remdesivir from a limited supply and which patients will be denied the possibly lifesaving medication. Rather than allowing the physician to decide what is best for each patient, Keystone State officials want physicians to give preference for Remdesivir to low-income persons in order to balance income inequalities.

This bureaucratic interference in medicine perverts fundamental medical ethics and substitutes social engineering for patient welfare.

Good physicians neither know nor care how much money a sick patient has. Real physicians do not practice “social justice,” seek to redress income inequality, or measure the value of one patient’s life against others using some government-approved metric. They do not act from some social or political agenda. Rather, they administer the best possible medical care for each individual patient. This is precisely why bureaucrats and politicians are not allowed to practice medicine.

A similar problem arose when, fearing a shortage of ventilators and beds in intensive care units, mayors in New York and Atlanta (as well as administrators in Maryland and Colorado) wanted life-and-death triage to be decided according to official state guidelines or crisis standards of care, rather than relying on the judgment of physicians on the scene.

Triage, the choice of which patients should be treated first (or at all) when resources are limited, is the ultimate medical decision and must be made by doctors. Prior to the current pandemic, the triage of sick or injured patients was always done by the doctor or nurse on the scene. But fears about the limited number of ventilators and an insufficient drug supply for those sick with COVID-19 has prompted bureaucrats to take over triage of critically ill patients using crisis standards, weighted lotteries, and other inappropriate official one-size-fits-all guidelines, which are actually mandates.

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Legally as well as ethically, neither the government nor any hospital has triage authority. The only person who can or should ever triage a patient is the attending physician or nurse, a licensed practitioner on the scene who accepts responsibility for that patient and is held accountable for that patient’s welfare.

Doctors practice personal medicine for individual patients, not “population medicine.” Crisis standards of care are intended to “prioritize survival of the group over survival of an individual patient during disasters,” such as the current pandemic.

As an emergency physician in Denver said, “Normally, we operate with the individual patient’s best interest at heart.” But during this pandemic, “You’re looking for the most good for the greatest number — it really is a shift.”

It is a shift — a shift we should not accept. A Colorado physician staring at 10 COVID-19 patients in respiratory failure and only eight ventilators is responsible for each of those 10 persons, not the other 600,148 residents of Denver.

Morally and legally, doctors practice personal medicine on individual patients, not population care.

We must protect the direct fiduciary connection between physicians and individual patients. There should be no outside person or group making drug choices. Medical decisions should be made solely for individual patients’ best interests, not for the greater good. Bureaucrats and legislators should not issue mandates that tell physicians how to practice medicine.

The only person who should triage you and care for you is a physician whom you chose, standing at the bedside. That is the one person who knows you and is responsible to you.

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Dr. Deane Waldman, M.D., is a professor emeritus of pediatric, pathology, and decision science, a former director of the Center for Healthcare Policy at the Texas Public Policy Foundation, and an author of Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.