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)

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

Just Posted

The first Pfizer-BioNTech COVID-19 vaccine dose in Canada is prepared at The Michener Institute in Toronto on Monday, Dec. 14, 2020. THE CANADIAN PRESS/Frank Gunn
One death, 39 new cases of COVID-19 in Interior Health

There are 484 active cases of the virus in the region currently

Amy Newman follows the route of the Cariboo Waggon Road — now Highway 97 — through Clinton. (Photo credit: New Pathways to Gold Society)
Grant received for Cariboo Waggon Road restoration project north of Clinton

New Pathways to Gold hopes to start work this summer on restoring sections of historic road

Dan Cumming (l, with Lisa Colwell, LPN) was one of 1,918 people who received their first COVID-19 vaccine at a community clinic in Ashcroft in early May. (Photo credit: Barbara Roden)
Vaccine clinics in Ashcroft, Clinton administered 2,664 first doses

Residents over the age of 18 are still eligible to receive their first COVID-19 vaccine

(from l) Ashcroft councillor Deb Tuohey, mayor Barbara Roden, and councillor Nadine Davenport at the opening of Ashcroft’s new water treatment plant in November 2019. At a recent town hall meeting, council said there are no immediate plans to install water meters in the village. (Photo credit: Christopher Roden)
Ashcroft homeowners face 2.5 per cent property tax bump in 2021

Village is moving ahead with variety of projects, but water metering not on the list of priorities

(from l) Cache Creek councillor Annette Pittman, mayor Santo Talarico, and councillors Wendy Coomber and Sue Peters at a budget meeting, May 7, 2021. (Photo credit: Facebook)
Cache Creek budget bylaws pass with one councillor opposed

Annette Pittman cites several reasons for voting against 30% tax increase and pool closure

B.C. Labour Minister Harry Bains in the B.C. legislature, May 13, 2019. (Hansard TV)
VIDEO: B.C. to provide 3 days of sick pay for COVID-19 absences

Province will support employers on cost, labour minister says

BC Housing minister David Eby. (THE CANADIAN PRESS/Chad Hipolito)
Eby jabs back against Penticton mayor’s ad urging BC Premier to intervene in shelter dispute

Eby writes that Penticton’s ‘serious’ social issues won’t improve under leadership of the mayor

Provincial health officer Dr. Bonnie Henry updates B.C.’s COVID-19 situation at the B.C. legislature, April 29, 2021. (B.C. government)
B.C.’s COVID-19 rate creeps up again, 600 new cases Wednesday

One more death, 423 people in hospital with virus

B.C. Agriculture Minister Lana Popham takes questions in the B.C. legislature in 2017. (Hansard TV)
UPDATE: B.C. will fund another year of fresh fruit, vegetables, milk in schools

John Horgan government working on school meal program

Surrey RCMP is releasing sketches of a suspect in an “indecent act” at the Coyote Creek Elementary playground on April 30, 2021. Police said the suspect was clean-shaven “during some interactions” and on “other occasions had stubble outlining a goatee and mustache.” (Images: Surrey RCMP handout)
Vancouver mayor-elect Kennedy Stewart addresses supporters in Vancouver on Sunday, Oct. 21, 2018. THE CANADIAN PRESS/Darryl Dyck
Vancouver mayor says there’s no time to redo details of drug decriminalization plan

Kennedy Stewart says a federal election could see the small window of opportunity close on the city’s bid for an exemption from criminal provisions on simple possession of small amounts of drugs

Premier Mike Horgan received his first dose of a COVID-19 vaccine. (Facebook/John Horgan)
More than 50% of people eligible in B.C. have received 1st vaccine dose

‘We’ve made extraordinary progress together over the past few weeks,’ says Premier Horgan

Brad MacKenzie, advocacy chair for the ALS Society of B.C., says having research projects in the province allows people here to have access to cutting-edge treatments now being developed. (B.C. government video)
B.C. funds research chair for Lou Gehrig’s disease at UBC

Pandemic has cut off patient access to international projects

Most Read