By Will Caraccio
There are five people in a lifeboat but only four can stay, who must leave the boat and drown to save the other four? The doctor, the elderly person, the parent, the richest, the one who asked first? In ethics class, this question is presented not as an extremely serious dilemma regarding life, death, and an individual’s moral worth, but instead as a interesting intellectual game—in real life, these moral dilemmas don’t concern us because they almost never occur.
However, in light of the COVID-19 pandemic that is sweeping the globe, our perspective regarding this strictly hypothetical dilemma is drastically changing; although the U.S. has thankfully not yet run out of ventilators, we’ve come alarmingly close. In early March, it was looking certain that we would run out of ventilators by April, and yet no unified ventilator triage policies emerged. With the constant threat of a second wave, we can’t afford to not have an ethical protocol to decide who will die and who will live in the case that we have to sacrifice lives due to shortages. This pandemic has brought reality dangerously close to that theoretical boat. Indeed, people are drowning all around us.
The first time I became aware of this terrible ethical dilemma that medical professionals are having to make on a daily basis is when my uncle, a surgeon in Spain, explained how ventilators were not given to people older than 70—I was shocked. He explained how, not too long ago, even transplants were not given to people older than 65. I realized that this fundamental problem is rooted not only in the field of medical ethics, but also in economics; there is a scarce resource and a decision must be made regarding who will get it. Traditionally, in our capitalist society, the market decides who receives certain limited goods by making those resources more expensive, enabling only the rich to acquire them. This is exactly what happened with testing in the early stages of the pandemic. When tests for COVID-19 were scarce and hard to get, doctors administered tests to patients who were willing to pay top dollar.
But when it comes to ventilators, devices that have the capabilities to preserve the life of humans struck by this terrible disease, the fundamental question “Who does and who doesn’t get a ventilator?” becomes very real.
At the moment, the ethical guidelines for dealing with a situation like this are inconsistent and confusing. Most major hospitals have adopted different ethical policies, and many smaller hospitals lack guidelines all together. However, as the pandemic progresses, and the issue regarding a scarcity of ventilators grows, a number of promising ethical measurements have emerged. According to Freakonomics, one way of navigating this extremely complicated ethical situation is by utilizing the so-called “SOFA” score, which stands for the Sequential Organ Failure Assessment. If your organs are more likely to fail, you get a higher score and vice versa. Using the SOFA score, doctors take into account patient comorbidities, and with the goal of saving the most years of life, medical professionals assign the patients a number—whoever’s number is the lowest gets a ventilator, and potentially, life.
When applied to real life, moral dilemmas are no longer delightful intellectual exercises, but instead, very weighty questions As the global pandemic worsens, I hope that medical professionals can start coming up with some answers.