A doctor gathers information from a driver arriving to get tested for COVID-19 at private laboratory Biomedica de Referencia, in the Lomas Virreyes neighborhood of Mexico City, Thursday, March 26, 2020. The new coronavirus causes mild or moderate symptoms for most people, but for some, especially older adults and people with existing health problems, it can cause more severe illness or death. (AP Photo/Rebecca Blackwell)

VIDEO: How doctors in Canada will decide who lives and dies if pandemic worsens

Officials in several provinces have been developing guides so that doctors don’t feel alone

When there’s only one ventilator but two patients who need it, how should a doctor decide who gets the chance to survive?

Medical ethicists across the country are working to help frontline workers answer weighty questions should the COVID-19 pandemic overwhelm hospitals the way it has in northern Italy and New York City.

“These are not decisions we want to make,” said Dr. Timothy Christie, who convenes an ethics committee that gives advice on pandemic response policy in New Brunswick.

“The planning that people are doing right now, they’re doing the best to make it so we don’t end up there.”

On Wednesday, chief public health officer Dr. Theresa Tam warned that Canada’s health-care system could be deluged in each of Ottawa’s pandemic scenarios. The system is not designed to deal with a surge of COVID-19 cases, which could mean facing difficult decisions about how to allocate sparse resources, she said.

Since the novel coronavirus was first confirmed in Canada, officials in several provinces have been developing guides so that doctors don’t feel alone in making life and death decisions.

British Columbia’s ethical framework builds on work started during the H1N1 epidemic and Ebola crisis. It addresses specific ethical questions on everything from distributing personal protective equipment and ventilators to “decision making about who will get scarce treatment if that comes to pass,” Dr. Bonnie Henry, the provincial health officer, said last week.

“No single individual physician or clinician will have to make that decision on their own.”

In Ontario, officials have announced the formation of an “ethics table” led by the University of Toronto’s joint centre for bioethics.

Alberta is working on a framework too.

“The focus will be on ensuring as many patients as possible receive the care they need,” Tom McMillan, a spokesman with Alberta Health, said in an email.

In New Brunswick, clinicians will be given a principle to help them make decisions based on their expertise.

Christie’s committee is recommending a fundamental shift in the underlying principle that doctors use to make treatment decisions if there aren’t enough hospital beds and ventilators.

“In cases where resources are limited, we would allocate the resources to people for whom we think will have the best outcome,” said Christie, who is also regional director of ethics services for the Horizon Health Network, the province’s anglophone health authority.

“That’s fundamentally different than the way we’d do it in normal circumstances.”

Under normal circumstances, Christie said doctors ask patients what their goals are. A patient with terminal cancer might wish to spend one last Christmas with his family, and treatment plans can be adjusted to help reach that goal.

COVID-19 could create a scenario where using a ventilator to keep someone alive for an extra few months comes at the expense of another person’s life, he said.

The challenge is determining how you define outcomes when comparing patients.

“There’s a lot of debate about how you define the best outcome. Some people would say it’s the amount of life you could live,” Christie said. In other words, choosing to save the younger of two patients.

“We reject that approach,” Christie said.

A 20-year-old and a 55-year-old both have ”significant” amounts of life left, so the difference between them is not morally relevant, he said.

Age isn’t the only factor being debated by the New Brunswick committee as it considers how to avoid discriminating against someone who develops COVID-19 after all ventilators are already in use.

Rather than stockpiling ventilators in anticipation of future cases, Christie said they are advising that a new patient be assessed against those already being ventilated. If the new patient has a good chance of surviving, doctors could ethically end the treatment for another patient who isn’t responding, he said.

But an ethical framework won’t help doctors who have to decide between two patients with nearly identical outcomes.

“In that circumstance you have an arbitrary decision. It’s going to be tragic, it’s going to be heartbreaking and it’s going to be arbitrary — and there’s no ethical principle that all of a sudden can make it better,” Christie said. “That’s no one’s fault.”

Amy Smart, The Canadian Press

Like us on Facebook and follow us on Twitter.

Coronavirus

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

MP Vis advocates for faster internet in rural communities

Less than 45 per cent of rural households in Canada have high-speed internet

Peace on the water

Harrison Lake was rather serene recently with the lack of usual traffic… Continue reading

UPDATE: Police oversight agency investigating after shots fired Saturday night in Chilliwack neighbourhood

RCMP reported a ‘distraught male’ fired at police officers on Christina Drive – IIO is on scene Sunday

Prospera Credit Union, Westminster Savings lay off over 100 staff following historic merge

2020 merger was largest credit-union merger in Canadian history

Facing changes together: Your community, your journalists

The COVID-19 pandemic has changed the world in ways that would have… Continue reading

Kelowna man charged with harming a hamster

The 20-year-old Kelowna man faces several animal cruelty charges

High tech fish transport system set up to ‘whoosh’ salmon past Big Bar landslide

Fish will spend roughly 20 seconds inside the system, moving at roughly 20 metres per second

Trudeau to seek 10 days of paid sick leave for Canadian workers, says talks are ongoing

Paid sick leave is key to keeping COVID-19 spread under control, prime minister says

Snowbirds jets will not be leaving Kamloops, just yet

The Snowbirds have been in Kamloops since May 17 when a plane crashed killing Capt. Jennifer Casey

COVID-19 checkpoints ‘up to them,’ Bonnie Henry says of remote B.C. villages

Support local tourism economy, but only if you’re invited in

Vancouver Island hasn’t seen a new homegrown case of COVID-19 in two weeks

Island’s low and steady transmission rate chalked up to several factors

Eight people arrested in Victoria homeless camp after enforcement order issued

Those living in tents were given until May 20 to move indoors

Most Read