Doctors’ ethical dilemma: Save the young or seniors?

Doctors’ ethical dilemma: Save the young or seniors?

Sunitha.Rao@timesgroup.com

Bengaluru:11.05.2021 

With an increasing demand for ICU beds and ventilators, clinicians are facing an ethical dilemma over allotment of beds: Young breadwinners or senior citizens? The focus is certainly more on saving the youngsters, multiple hospital authorities told TOI on the condition of anonymity.

“Age has to become a criterion for ICU admission, apart from the patient’s condition. Not that we are denying treatment for the elderly patients outright, but we do feel sorry for the families of young patients suffering from severe forms of the disease,” said an intensivist.

The head of a hospital in west Bengaluru told TOI that he had never faced such an ethical dilemma in his 35-year career. “Who should get priority, given the limited resources? From a medical practitioner’s perspective, we can’t differentiate between the young and the old. Now, it is different. Between an ailing senior citizen whose prognosis suggests s/he may not make a recovery and a young man who has chances of survival, I would go for the latter. We do explain the situation to the families,” the doctor said.

Hospital authorities say their focus is certainly more on saving the youngsters

Disease severity a criterion, not age: Doc

There are very few hospitals that have the extracorporeal membrane oxygenation (ECMO) therapy, which is used to pump and oxygenate a patient’s blood outside the body, replacing the function of the lungs and heart.

“We have had a 44-year-old man on ECMO for the past three weeks and he is making subtle but gradual improvement. There was only one ECMO machine. A week ago, we had a 22-year-old woman who recently required ECMO. She died in front of us. Being helpless is adding to our stress. Each life we are losing was the one that should have been saved,” said an intensivist from a corporate hospital in Bengaluru.

Besides age, the patient’s class matters as they get multiple calls if s/he is from an influential background.

With resource crunch, NGOs helping several critical patients find a bed admit they do make a choice. “If the Covid patient is young and the only breadwinner of the family, we do make our best attempts to help find a bed,” says Mohammed Ismail, a volunteer working with Emergency Response Team of Mercy Mission.

“On April 30, we received a request from the family of a 32-yearold man, whose oxygen saturation level was 70% and the private hospital where he was had no ventilator for him. His parents had died the previous day and his pregnant wife had gone for their cremation. We had to speak to several MLAs, officers to get him a bed and he was finally shifted to Victoria Hospital,” Ismail said. The priority goes for a young breadwinner of the family, pregnant women in need of ICU beds, he added.

But some doctors look at the treatment path. The only criteria between an old and a young patient would be who is the sicker of the two, said Dr Smitha Thimmaiah, medical superintendent, Sparsh Hospital, Mysore Road. “If my parents were in this situation, I would not have ignored considering their age, right? The same is applicable to any other patient too. Age is not the criterion, but the disease severity and the need of treatment are,” said Dr Smitha.