Is It Moral to Give Ventilators Only to the Healthiest Patients?

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Clare Malhotra ('22)

Young people are often prioritization when there aren't enough ventilators.

Clare Malhotra, Staff Writer

As coronavirus, or COVID-19, cases swelled, Italian hospitals found themselves stuck without enough ventilators, beds, doctors, or supplies to treat the floods of patients. Soon it came down to the point where they had to choose who to try to save and who to turn away. They ended up prioritizing young, healthy people and turning away those over the age of sixty. Is it ethical to treat only those most likely to recover?

It’s a similar process to that which determines who goes to the top of the list for organ donations. While it is sometimes based on the person in most dire need of a transplant, the person who gets priority is frequently younger, healthier, and less likely to die after the transplant, thus minimizing the potential waste of an organ. But the problem of coronavirus treatment is not wasting an organ. If someone dies, their ventilator doesn’t die with them; it’s open and available for the next sick person. 

Elderly people are more likely to experience complications with the virus and die—as are the immunosuppressed, or those who have preexisting conditions such as diabetes. Part of the reason Italy’s death rate is so high—higher than the global average—is because the country’s population has a higher average age. The mortality rate is effectively 0 percent for those under nine, 0.02% for those ages 10-19, and 0.09% for those ages 20-29. The rates increase with age—those over 80 have an 18 percent chance of mortality. There are generally two perspectives when deciding who to treat: those who need medical care most urgently come first, or those most likely to survive the disease come first.

In cases where the mortality rate only slightly increases with age, it seems logical to treat children first. They are younger, healthier, more likely to survive, and they have their whole lives ahead of them; it makes sense to give them the best chance of survival possible. But in the case of coronavirus, the case of children dying is already so minimal. The first case of a minor possibly dying from coronavirus in the United States occurred just last Tuesday. 75,178 people in total have died in the US, and this is before much strain on resources. To treat any child that comes into the hospital—as Italy has done—prevents hardly anyone from dying, but turning away hundreds of adults and elderly people can very well be the cause of many deaths. This is not to say that no child should be treated, but they all people should be monitored to ensure prioritization based on the direness of their situation.

The decision will come to the United States soon on who to prioritize with regard to the distribution of ventilators. One pediatrician named Aaron E. Carroll noted in a New York Times article that, “We have about 45,000 intensive care unit beds in the United States. In a moderate outbreak, about 200,000 Americans would need one.” The United States must make a decision soon.