Preparing Ahead Wisely And Ethically to Stave Off Crisis Standards of Care MARGARET R. McLEAN, MDiv, PhD Department of Religious Studies, Markkula Center for Applied Ethics, Santa Clara University
A
round every corner of the COVID-19 pandemic await questions of ethics, perhaps none so unanticipated and vexing as the fair distribution of scarce medical resources. Beginning on day one of the pandemic with a shocking lack of personal protective equipment (PPE), patients and professionals have faced a reality long slumbering, undisturbed in the bowels of the decentralized health care system in the United States: the rationing of health care resources. In emergency rooms from coast to coast, the pre-pandemic default of seeing all comers became impossible and treating based on need was supplanted by the calculus of cost-benefit. Scarcity affected ventilators, staffed beds, antivirals, monoclonal antibodies, oxygen and blood products — a sign of failing preparation for a global public health crisis. To demonstrate the stark reality of pandemic unpreparedness, consider the following description of New York City in April 2020 as America’s health care system buckled in response to SARSCoV-2 reaching its shores: Tents are now strewn across Manhattan’s Central Park — field hospitals in the literal sense — that resemble the convalescence wards of the 1918 flu pandemic. They sit a stone’s throw from some of the world’s most expensive real estate. Not to mention some of the world’s most luxurious brick-andmortar hospitals. ... At a certain point, the calculus of American doctors will switch from the default of preferentially caring for the person who appears sickest to caring for the person with the greatest chance of benefiting from care.1 The ongoing scramble for medical resources continues to teach hard lessons about the impor-
12
SPRING 2022
tance of disaster preparedness.2 The United States was woefully unprepared, caught by surprise by SARS-CoV-2, not having heeded the warning bells of Ebola, SARS, H5N1 and others. We should have been better prepared for public health disaster as individuals and a country — yes, there would have been sickness and death, but nowhere near the mind-numbing numbers of over 78 million infections and more than 950,000 deaths. Our tendency to ignore the possibility of catastrophe until the flood waters reach the roof only further deepens the disaster and ensuing despair.
BE PREPARED
Our primary ethical obligation in meeting the challenges of crisis response is to be prepared, a haunting and woefully unfulfilled responsibility during this pandemic as our decentralized, market-driven health care system faced critical shortages of supplies and staff, negatively impacting hospitals, long-term care facilities, health care providers and, critically, those they serve. “Just-
www.chausa.org
HEALTH PROGRESS
