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

A second wave of COVID-19 is probable, if history tells us anything

B.C.’s top doctor says that what health officials have learned this round will guide response in future

Morning start: Rossland is named after this person

Here is your Kootenays’ morning start for Friday, May 22

Snow expected to hit West Kootenay passes overnight on Thursday

Up to 15 cm of snow could fall on Highway 3 between Paulson summit to Kootenay Pass by Friday morning

Construction for New Denver child care centre on time and on budget

The child care centre is set to open on September 8 at Lucerne Elementary School

Creston flour mills overwhelmed by COVID-19 demand

Flour shortage highlights region’s grain insecurity

LIVE: Procession to honour Snowbirds Capt. Jennifer Casey comes to Halifax

Snowbirds service member died in a crash in Kamloops one week ago

RCMP facing ‘systemic sustainability challenges’ due to provincial policing role

Provinces, territories and municipalities pay anywhere from 70 to 90 per cent of the cost of the RCMP’s services

One man dead after standoff with Chilliwack RCMP

The Independent Investigations Office of B.C. is investigating the RCMP’s role in the death

B.C. employers worry about safety, cash flow, second wave in COVID-19 restart

A survey found 75 per cent of businesses worry about attracting customers

Ex-BC Greens leader Andrew Weaver says province came close to early election

Disagreement centred on the LNG Canada project in northern B.C.

Canada’s NHL teams offer options to season-ticket holders

Canadian teams are offering refunds, but also are pushing a number of incentives to let them keep the money

B.C. premier says lessons to learn from past racism during response to pandemic

B.C. formally apologized in the legislature chamber in 2008 for its role in the Komagata Maru tragedy

Snowbirds to remain at Kamloops Airport indefinitely after fatal crash

small contingent of the Snowbirds team is staying in Kamloops, acting as stewards of the jets

Oak Bay man stumbles upon eagle hunting seal, grabs camera just in time

The eagle did ‘a perfect butterfly stroke to shore’ with its prey, photographer says

Most Read