People are sorting through the lessons that can be learned from the coronavirus crisis, on issues from the adequacy of medical stockpiles to emergency food supplies. The pandemic has highlighted real weakness in American preparedness, while heroic health-care workers show up to work every day trying to save lives at great personal cost. But a dirty little secret has come to light: As the number of infections rose, leaders have openly discussed rationed care as preset policy.
For years, number-crunchers have worked to create math for judging whether people’s lives should be saved based on a quality-of-life calculation. Reporting on medical rationing in light of the Wuhan virus, The New York Times’ Sheri Fink observed, “In the United States, some guidelines already exist for this grim task. In an effort little known even among doctors, federal grant programs helped hospitals, states and the Veterans Health Administration develop what are essentially rationing plans for a severe pandemic. Now those plans, some of which may be outdated, are being revisited for the coronavirus outbreak.”
Rationing Formulas May Mistreat People with Disabilities
It begins with a tool for evaluating who is worth it. For example, the government-run health care in Britain evaluates “value for money” before signing off on medical intervention, as The Atlantic reported recently in an article about COVID-19. The bureaucrats’ goal is to find “the best way to distribute the finite pot of government money allocated for health care.”
Lives are measured in QALY, quality-adjusted life years, which equals one year of life in perfect health. In Britain, the government will spend $25,000 to $38,000 for a year of healthy life. Consider that the average cost of treating cancer for a month here in the United States is $10,000, and it’s clear that people will be left to suffer.
In fact, that same QALY formula is advocated in the United States by the Institute for Clinical and Economic Review (ICER), a self-appointed health-care cost watchdog that regularly issues reports on whether it’s worth the money to prolong or save the lives of the sick or disabled. ICER is composed heavily of people who helped construct the Affordable Care Act and people with ties to socialized medical systems worldwide.
This economic assessment puts a price tag on life, and as the Wall Street Journal noted, people are paying attention. According to Forbes, “ICER is partly responsible for reintroducing the discussion of explicit rationing in the U.S.”
Two of my four children have a genetic condition, cystic fibrosis, that leads to breathing difficulties. They are happy, healthy, and thriving, but their lung condition is permanent and requires medical intervention each year. Recently, ICER issued a report on why the drug Trikaft, which has proved life-changing for my son, should be denied to cystic fibrosis sufferers. Even though some medical professionals have been quoted saying Trikafta could add as much as a decade to my son’s life expectancy, ICER didn’t think the years he would gain justified the cost.
Concerned about people with disabilities like cystic fibrosis and how they might be treated during the coronavirus crisis, the Center for Public Integrity looked at states’ plans for rationing care and equipment. It found that 25 states would ration care “in ways disability advocates have denounced” and noted that all but “five had provisions of the sort advocates fear will send people with disabilities to the back of the line for life-saving treatment.” The policies of the remaining 20-plus states were unknown or undisclosed.
Significant for my family, reporter Liz Essley Whyte noted, “Policies and guidelines in five states — Alaska, Florida, Oklahoma, Vermont and Wisconsin — specify that patients with cystic fibrosis, a genetic lung disease that affects about 30,000 people in the U.S., should be considered lower priority for a ventilator.”
Rationing Policies Can Violate Civil Rights
But it’s not a person’s condition that should lead automatically to rationing, which should take place only if equipment is unavailable, Dr. Donna Harrison, executive director of the American Association of Pro-Life Obstetricians and Gynecologists, told me. “As in catastrophe triage, those decisions should be made on the basis of the prognosis of that person to overcome the stage of the disease occurring at that moment in time, not on characteristics like anticipated quality of life, which leave open the patient to the biases of the decision-maker,” she said.
Faced with fears of illegally rationed care, the National Council on Disability asked the U.S. Department of Health and Human Services to ensure treatment won’t be denied. The HHS Office of Civil Rights responded with a bulletin reminding health providers of the civil rights of patients in their care. Office of Civil Rights Director Roger Severino said: “Persons with disabilities, with limited English skills, or needing religious accommodations should not be put at the end of the line for health services during emergencies. Our civil rights laws protect the equal dignity of every human life from ruthless utilitarianism.”
No national rationing guideline is in place. For the most part, rationing guidelines go from state health departments, to hospitals and physicians, down to the granular level, as medical professionals weigh the choices before them. As a result, governors are perhaps the best line of defense in choosing state health department professionals committed to the Hippocratic Oath and in articulating goals to treat all people without prejudice about their perceived potential.
In a medical emergency, physicians make tough calls, but this crisis has uncovered problems with rationing policies: Economic considerations are replacing the goal of life-affirming care for some. Ending a life may be cheaper than treating a patient, but that’s why when people are ill, they see doctors — not accountants.