(RNS) — Social emergencies can stretch our cultural fabric to the limit.
Those of us who remember 9/11 probably also remember the feeling that, however we responded, we needed to make sure our foundational cultural values were respected. Time and time again we heard some version of, “If we do X, then the terrorists win.”
Looking back, it is clear we fell well short of that goal.
We abandoned our privacy to a surveillance state established by legislation named the Patriot Act. We rushed off to a needless war of aggression in Iraq. Our CIA tortured people at so-called black sites away from public scrutiny. Our soldiers did disgusting and illegal things to prisoners at Abu Ghraib.
Now, with the novel coronavirus pandemic, we may face a compromise of our values that will be significantly worse than 9/11. Indeed, the cultural damage may already be outpacing the deaths we have seen.
And it is about to get worse.
Hospitals in many places in the U.S. in the next weeks will be absolutely swamped. Anyone who has been paying attention to the numbers already knows we simply don’t have enough ICU beds, ventilators, staff and medical equipment to treat the coming flood of patients.
Indeed, some doctors are even wondering if, when they run out of ventilators, they could recruit volunteers to manually ventilate patients by essentially squeezing a baglike device over and over. New York state has a shortage of hospital beds and personnel: It is recruiting retired nurses and doctors (and even nursing and medical students) to help staff facilities.
We must see this as a cultural moment to decide not to make the mistakes of the past. Though the culture needs to and will change dramatically to meet this new threat, we must not abandon the values that make us who we are.
The claim that “we’re at war” is, at best, a mixed blessing. Yes, we all need to ramp up our efforts to fight this new, invisible enemy, but historically being at war means we risk violating our most fundamental values.
The overwhelming majority of health care workers fighting this disease are rightly going to be honored when this is over as our nation’s heroes. Their self-sacrifice, which for some will mean sacrificing of their lives, is simply extraordinary. Practicing medicine is a vocation, a calling. And we are so blessed to have people with this vocation on our side.
But you don’t need to read too much history of medicine to know about its dark side. From horrific Nazi medicine in Germany to the utterly shameful Tuskegee syphilis trials in the U.S., we can see that those who hold power in medicine sometimes make terrible decisions that also undermine the foundational values of a culture.
More recently, New York Times investigative journalist Sheri Fink uncovered the terrible things done at New Orleans’ Memorial Medical Center in the aftermath of Hurricane Katrina. Due in no small part to their age and level of ability, several patients were euthanized by hospital staff with overdoses of pain medication. Dr. Anna Pou faced prosecution for her direct role in these killings, but after her colleagues and the American Medical Association came to her defense, a grand jury declined to indict her.
If the stress the pandemic has put on the rest of the world is any measure, the U.S. health care system will find itself under pressure to similarly abandon our core values. There are already reports that hospitals in Spain are refusing to treat people over the age of 65. In Italy they are reportedly not treating them when over 60.
These kinds of practices — born out of the simplistic utilitarianism that dominates so much of medicine and medical ethics in the developed West — would be a direct violation of the civil rights of older U.S. Americans. Under the Age Discrimination Act of 1975, hospitals that receive federal funding (which includes Obamacare) “may not exclude, deny, or limit services to, or otherwise discriminate against, persons on the basis of age.”
Happily, New York’s state protocol for rationing ventilators rejects advanced age as a triage criterion “because it discriminates against the elderly.” Indeed, the document notes that age “already factors indirectly into any criteria that assess the overall health of an individual” and “there are many instances where an older person could have a better clinical outlook than a younger person.” Hospitals, medical teams or rationing officers “should utilize clinical factors only to evaluate a patient’s likelihood of survival” when allocating scarce resources.
But Washington state, also a center of the outbreak in the U.S., has taken a much different approach. According to reporting from NBC News, last week 280 clinicians in that state got on a conference call to discuss their own protocols. They agreed that if they reached “crisis standards” things would have to change dramatically.
“If you are above a certain age and we have a shortage of ventilators, you don’t get one,” said Cassie Sauer, CEO of the Washington State Hospital Association.
Fink’s coverage found that in “guidance endorsed and distributed by the Washington State Health Department” crisis conditions in that state should consider transferring patients out of the hospital or to palliative care if their baseline functioning was marked by “loss of physical ability” or “cognition.”
This is blatant discrimination against the disabled and also clear violation of civil rights.
It is also a classic example of what Pope Francis describes as our consumerist “throwaway culture,” in which the value of human beings is often measured by their quality or productivity. Especially when their dignity is most inconvenient for us, the most vulnerable are at particular risk for being thrown away.
The New England Journal of Medicine recently claimed that this kind of health care rationing is “is often better tolerated when done silently.”
It is now, before the storm hits, that we must be committed to making sure that these decisions are not made silently, without public scrutiny. Instead, we must insist on being part of a very public discussion over the most ethical ways to allocate scarce medical resources.
That is, allocate them in ways that reflect our foundational cultural values.