Talk about always wondering.............
Another thing I've always pondered.......... and here it is!!!!!
eileen

http://news.yahoo.com/s/ap/20080505/ap_on_he_me/pandemic_rationing_care

By LINDSEY TANNER, AP Medical Writer
Mon May 5, 9:47 AM ET

CHICAGO - Doctors know some patients needing lifesaving care won't get
it in a flu pandemic or other disaster. The gut-wrenching dilemma will
be deciding who to let die.

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Now, an influential group of physicians has drafted a grimly specific
list of recommendations for which patients wouldn't be treated. They
include the very elderly, seriously hurt trauma victims, severely
burned patients and those with severe dementia.

The suggested list was compiled by a task force whose members come
from prestigious universities, medical groups, the military and
government agencies. They include the Department of Homeland Security,
the Centers for Disease Control and Prevention and the Department of
Health and Human Services.

The proposed guidelines are designed to be a blueprint for hospitals
"so that everybody will be thinking in the same way" when pandemic flu
or another widespread health care disaster hits, said Dr. Asha
Devereaux. She is a critical care specialist in San Diego and lead
writer of the task force report.

The idea is to try to make sure that scarce resources — including
ventilators, medicine and doctors and nurses — are used in a uniform,
objective way, task force members said.

Their recommendations appear in a report appearing Monday in the May
edition of Chest, the medical journal of the American College of Chest
Physicians.

"If a mass casualty critical care event were to occur tomorrow, many
people with clinical conditions that are survivable under usual health
care system conditions may have to forgo life-sustaining interventions
owing to deficiencies in supply or staffing," the report states.

To prepare, hospitals should designate a triage team with the Godlike
task of deciding who will and who won't get lifesaving care, the task
force wrote. Those out of luck are the people at high risk of death
and a slim chance of long-term survival. But the recommendations get
much more specific, and include:

_People older than 85.

_Those with severe trauma, which could include critical injuries from
car crashes and shootings.

_Severely burned patients older than 60.

_Those with severe mental impairment, which could include advanced
Alzheimer's disease.

_Those with a severe chronic disease, such as advanced heart failure,
lung disease or poorly controlled diabetes.

Dr. Kevin Yeskey, director of the preparedness and emergency
operations office at the Department of Health and Human Services, was
on the task force. He said the report would be among many the agency
reviews as part of preparedness efforts.

Public health law expert Lawrence Gostin of Georgetown University
called the report an important initiative but also "a political
minefield and a legal minefield."

The recommendations would probably violate federal laws against age
discrimination and disability discrimination, said Gostin, who was not
on the task force.

If followed to a tee, such rules could exclude care for the poorest,
most disadvantaged citizens who suffer disproportionately from chronic
disease and disability, he said. While health care rationing will be
necessary in a mass disaster, "there are some real ethical concerns
here."

James Bentley, a senior vice president at American Hospital
Association, said the report will give guidance to hospitals in
shaping their own preparedness plans even if they don't follow all the
suggestions.

He said the proposals resemble a battlefield approach in which limited
health care resources are reserved for those most likely to survive.

Bentley said it's not the first time this type of approach has been
recommended for a catastrophic pandemic, but that "this is the most
detailed one I have seen from a professional group."

While the notion of rationing health care is unpleasant, the report
could help the public understand that it will be necessary, Bentley
said.

Devereaux said compiling the list "was emotionally difficult for
everyone."

That's partly because members believe it's just a matter of time
before such a health care disaster hits, she said.

"You never know," Devereaux said. "SARS took a lot of folks by
surprise. We didn't even know it existed."

___

On the Net:

CHEST: http://www.chestjournal.org

U.S. Govt.: http://www.pandemicflu.gov