Monday, December 28, 2020

Who Dies and Who Lives? Older Adults and Crisis Standards of Care

 




Nine months ago, some policymakers suggested that older adults should sacrifice their lives “for the good of the economy” and that a robust economy required sacrifice from older folks.  Lieutenant Governor Dan Patrick stated on Fox News that “seniors must be willing to die for the Dow, as shutting down the economy to stop the pandemic would create a collapsed economy.”  Grandma has to die for the sake of the market, right? It was such an abhorrent idea that tongue-in-cheek posters made the rounds of the internet. Not all of it was targeted toward older adults.

Die for the Dow gained traction as an idea too absurd to leave alone. One clever artistic poster by Fernando Reza posed this question: “Is your selfish determination to live holding back our economy?” “Die for the Dow” featuring Trump hair skull and crossbones was available in postcards, posters, magnets, and greeting cards. On May 21, Paul Krugman wrote an editorial in the New York Times and illuminated Trump and the Republican Party stance, that “their basic position is that thousands of Americans must die for the Dow” (para. 4) to protect the robust stock market instead of creating plans to curb the spread of the pandemic. As public health experts tried to stop COVID-19 from spreading, Team Trump denied the seriousness of the threat and promoted a brisk reopening no matter how many people died.

Fast forward to December 2020. Today in the United States, 19.2 million people are infected with CV-19 and 333,000 people have died. In some areas, hospitals are at full capacity and it is estimated that more will be infected and die. The CDC (2020) projections from 23 December indicate that by January 16, there will be 378,000 to 419,000 deaths, with 16,000 to 24,000 of them counted as new deaths.

With hospitals at full capacity or over capacity, will medical staff decide who dies and who lives? This crisis has prompted concerns among older adults that they will be asked to sacrifice their lives for the good of the economy. And this time, it’s not an anecdote, it’s real.

The National Academy of Medicine (NAM, 2020) and nine other national organizations are asking for proactive plans to be put in place now before agonizing decisions are made. These organizations include governors, state health departments, and hospital and healthcare systems. The recommendations from the NAM (2020) include individualized assessments of each patient and that such assessments will NOT use categorical exclusion criteria based on age or disability…. And that “judgments as to long-term life expectancy; evaluations of the relative worth of life, including through quality of life judgments, and should NOT deprioritize persons based on disability or age because they may consume more treatment resources or require auxiliary aids or supports” (para 5). We can’t go back and change what has happened but we can go forward armed with how to fight the CV-19 killing machine. Strategies from the experts include social distancing, hand washing, sing hand sanitizer, mask wearing, clean and disinfect surfaces, monitor your health daily, and get a flu vaccine.

 

References:

CDC (23 December 2020). COVID-19 Forecasts: Deaths. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/forecasting-us.html

 

Krugman, P. (21 May 2020). How many will die for the Dow? The New York Times. Retrieved from

https://www.nytimes.com/2020/05/21/opinion/trump-coronavirus-dow.html

 

National Academy of Medicine (18 December 2020). National organizations call for action to implement crisis standards of care during COVID-19 surge. Retrieved from  https://nam.edu/national-organizations-call-for-action-to-implement-crisis-standards-of-care-during-covid-19-surge/

 

 

 


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