Life & Death

The new United States guidelines on who should and should not get care in catastrophic events and disasters that was released yesterday by a multi- disciplinary task force whose members includes people from various medical groups, military, academe and government agencies such as the Centers for Disease Control and Prevention, the Department of Health and Human Services and the Department of Homeland Security will surely elicit a lot of criticisms from various sectors by citing that Doctors and Health Practitioners should not be given the God-like task to determine who should receive treatment or not or to put it more bluntly, who should live or die.

The said guidelines is an ethical nightmare anyway you look at it since it will affect a lot of people and it is quite understandable for some people to oppose the said recommendations.

And it is never easy for any person, more so to people who have sworn to save lives to the best of their abilities to be confronted with this kind of dilemma but we need to bite the bullet when the worst- case scenario occur to preserve vast needed resources both in manpower and supply.

Aside from the obvious that cover people with the highest risk of death or very slim chance of survival owing to the degree or severity of an injury or illness, the guidelines also 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.


In this age of terrorism and super- bugs, I deemed it as a wise move (although with reservations) from the authorities to come up with the guidelines to follow in the event of a massive catastrophe so as to avoid the same confusion that occurred in various hospitals following the 9-11 Terrorist attacks where medical personnel were overwhelmed by the sheer volume of casualties.

Let’s just hope that the medical personnel that will be manning the triage if ever the circumstance calls for it will be knowledgeable and competent enough to handle this life and death questions in their midst.

You can read the controversial guidelines from the May 2008 issue of Chest, the American College of Chest Physicians Journal entitled DEFINITIVE CARE FOR THE CRITICALLY ILL DURING A DISASTER