OTHER DOCUMENTS

[Clicking on a document opens it from the source.]

 

Agency for Healthcare Research and Quality. Altered Standards of Care in Mass Casualty Events. (AHRQ Publication No. 05-0043, prepared by Health Systems Research Inc.) Rockville, MD: Agency for Healthcare Research and Quality, April 2005.

This recent government document presents two mass casualty scenarios [pp. 9-10] and notes, with regard to "current patients, such as those recovering from surgery or in critical or intensive care units" that "certain lifesaving efforts may have to be discontinued."
 

Homeland Security Council. National Strategy for Pandemic Influenza: Implementation Plan. May 2006. [This document ceased to be available online from www.whitehouse.gov on 1/20/09, even though it continues to be referenced on other government sites.]

See especially, under Medical Standards of Care: "In some circumstances, it may be necessary to apply triage principles in the hospital to regulate which patients gain access to intensive care units (ICUs) and ventilators..." [p. 110]. Also: "The legal and ethical 'standard of care' ...is what is reasonably expected of medical systems and providers and is determined by extant circumstances. Relevant conditions include the availability of hospital, ICU, or specialty care beds; medical equipment and materiel; and personnel who are trained and qualified to provide care. As in all situations involving the allocation of scarce medical resources, the standard of care will be met if resources are fairly distributed and are utilized to achieve the greatest benefit. In a pandemic, hospital and ICU beds, ventilators, and other medical services may be rationed. As in other situations of scarce medical resources, preference will be given to those whose medical condition suggests that they will obtain greatest benefit from them. Such rationing differs from approaches to care in which resources are provided on a first-come, first-served basis or to patients with the most severe illnesses or injuries." [p. 110]
 

New York State Workgroup on Ventilator Allocation in an Influenza Pandemic --New York State Department of Health / New York State Task Force on Life and the Law. Allocation of Ventilators in an Influenza Pandemic: Planning Document. Draft for Public Comment, March 15, 2007.

This report is one of a number of informative resources from the New York State Department of Health web page for Influenza Pandemic. It addresses straightforwardly the most problematic issue of removing patients from ventilators "against their wishes" [p. 35; see also especially pp, 17-18 and 37]. The authors rely heavily on the triage protocol proposed in Hick, J. L. and O'Laughlin, D. T., "Concept of Operations for Triage of Mechanical Ventilation in an Epidemic," Academic Emergency Medicine 13, no. 2 (February 2006): 223-229.
 

Philadelphia Metropolitan Area Medical Advisory Committee. Pandemic Influenza Planning Guidance for Healthcare Institutions. Philadelphia Department of Public Health, September 2007.

This is a report of the work of groups of regional experts, convened and organized by the Philadelphia Department of Public Health, beginning in May 2006. It offers guidance and recommendations for local hospitals. It explicitly mentions ethical concerns only in passing, twice (--see pp. 7 and 30). However, it does address a number of ethically pertinent issues in pandemic planning and response: see especially the sections, Approaches to Altered Standards of Care (pp. 9-10), Critical Care Pandemic Triage (p. 30-34), and Standards of Patient Care (p. 93). The report notes especially the triage protocol proposed in Christian, M. D., et al., "Development of a triage protocol for critical care during an influenza pandemic," CMAJ: Canadian Medical Association Journal 175, no. 11 (November 21, 2006): 1377-1381. The report and other material related to pandemic influenza preparedness is available on the City of Philadelphia website at www.phila.gov/health/units/ddc/Pandemic_Influenza_P.html.
 

US Department of Health and Human Services. HHS Pandemic Influenza Plan. November 2005.

"Despite planning and preparedness, however, in a severe pandemic it is possible that shortages, for example of mechanical ventilators, will occur and medical care standards may need to be adjusted to most effectively provide care and save as many lives as possible" [p. S3-3]. See also, under Psychosocial Issues for Response Workers, "Belief that medical resources are not available or fairly distributed" [p. S11-8] and under Impact of Pandemic Influenza on Healthcare Workers, "Ethical dilemmas..." [p. S11-9]. In addition, note that regarding the distribution of antiviral drugs, priority is given to "patients admitted to hospital" ..."Consistent with medical practice and ethics to treat those with serious illness and who are most likely to die" [p. D-21].
 

US Department of Veterans Affairs, National Center for Ethics in Health Care. VA Staff Discussion Forums on Ethics Issues in Pandemic Influenza Preparedness, 2006.

The site offers materials for staff discussion on a wide range of ethical issues, and provides a transcript from a June 27, 2006 National Ethics Teleconference [on] Influenza Pandemic Preparedness Planning: Ethics Concerns [--Word document, opens in a new window].