Hospitals need ways to make rational fair decisions about who gets ICU beds and ventilators if COVID-19 patients overwhelm capacity. Douglas B. White, MD, MAS, Director of the Program on Ethics and Decision Making in Critical Illness at the University of Pittsburgh, discusses a framework for making those decisions. Originally streamed Friday March 27 at 12 noon CDT (GMT-5).
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Read the proposal summary at:
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Topics discussed in this interview:
Could you say a bit about your co-author, Bernard Lo? (0:55)
You’re an ethicist and an intensivist. How did you combine these two disciplines? (1:18)
The focus today will be on ventilators and critical care beds. But how do you think about rationing in the broader sense? (1:58)
Categorically excluding large groups of patients from receiving mechanical ventilation Is ethically problematic (4:08)
It is ethically insufficient to solely focus on survival to hospital discharge (6:31)
Were there other models that you drew on besides the lung allocation scoring system? (9:02)
Recommendations for a multiprinciple allocation framework (9:46)
More guidance is needed on withdrawing life support from one patient to provide it to another (10:06)
In ICUs, after someone’s been on a ventilator for a long period of time, there are decisions made about how long they should remain on a ventilator. Are these situations different? (12:08)
Can you talk more about this framework that you’ve helped develop? (13:05)
Do you know if any of this approach has been used in Italy? (14:49)
I have enormous respect for Maurizio Cecconi, MD and what he has been going through in Italy (15:48)
So how is this document being used at this moment? (16:43)
Creation of triage teams (19:02)
Allocation criteria for ICU admission/ventilation (21:00)
What happens if you have 3 patients with acute respiratory failure but only 1 ventilator. (Secondary criteria) (24:24)
Reassessment for ongoing provision of critical care/ventilation (27:27)
Different cultures and religions view these issues differently. How does this framework address that? (29:36)
How do you think about the rationing of tests and personal protective equipment (PPE)? (31:25)
Do you have a sense of why such a large number of health care workers are getting infected. (33:31)
Is it ethical to double ventilate on a single ventilator knowing that this might be harmful to some patients? (35:01)
Hospitals and nursing homes are limiting visitors. Will families be able to visit patients dying of COVID-19 in ICUs? (36:51)
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