Read more: Health, Local, Swine, Flu, Pandemic, Treatment, Ethics, Severe, Medical
The closer an influenza patient is to death during a severe pandemic where medical resources would be scarce, the more likely they'll be excluded from admission to an intensive care unit. That's the recommendation from a task force studying ethical dilemmas during pandemics.
Months before the world was introduced to the swine flu, the S.C. Department of Health and Environmental Control commissioned a task force to take a look at the state's preparedness plan for a severe influenza pandemic.
"We found (we) had more work to do, DHEC does, particularly in dealing with scarcity of medical resources in a pandemic," said Dr. Phil Schneider, an emeritus bioethics professor at CCU and co-chair of the SC Pandemic Influenza Ethics Task Force.
"There's no point in putting treatment into a patient who will not benefit from it. Tough thing to say, but that's what we're going to be faced with in a full-fledged pandemic," Schneider said.
A key component of battling influenza is ventilators. As of June, there were 1,284 ventilators in hospitals across the state, according to the task force.
How those would be rationed during a severe pandemic where tens of thousands could possibly benefit from a ventilator is an "ethical" choice, and one where the task force is weighing in.
"The doctors will have to decide who the sickest people are and who are the people who have the best chance to survive," Schneider said.
To determine who will receive critical care, specifically ventilators, the task force recommends hospitals implement the Sequential Organ Failure Assessment (SOFA) System, which rates a patient's mortality risk.
Through a series of testing, the patient will be given a score between 0-24. The higher the score, generally higher than 11, the closer one is to death and less likely they'll receive critical care, Schneider said.
"If we have two patients, one whose SOFA score is 18 (who's) 99% likely to die with whatever treatment they have, ventilator or not ... and a patient with a SOFA score of 4 who is very likely to survive if they can get the treatment with the ventilator, then the patient with the lower score will get the ventilator," Schneider explained.
The one who is refused the ventilator will be given palliative care where the treatment is focused on making "end of life" easier -- much like a hospice program.
Schneider said the task force has worked hard to arrive at the best ethical recommendations -- ones that are fair, transparent, and those that provide the greatest benefit for the greatest number of people.
"If we have 100 people who can survive and one that can't, we want to put our treatment on the people who have the highest chance to survive."
It is, in a nutshell, treating those who can be treated.
"This is necessary. It's fair. It's evidence-based. It's not pleasant, but it's something our society has to cope with."
Schneider said the state's hospital and medical associations have endorsed the plan, and they hope the nursing association will follow suit.
This is just one section of the study that can be read in its entirety by clicking here.
