I took an oath when I graduated from medical school. The ancient, powerful words of the Hippocratic Oath are seared into the brain of every physician: “First, do no harm.” I, along with every physician who has come before me, hold myself to that standard. Every time I go to work, my goal is to deliver the best treatment to any patient who seeks my care. Yet I worry I may not be able to keep my oath. In the coming weeks, the number of patients who are critically ill with the novel coronavirus may exceed our health care system’s resources. Simply put, we may not have enough equipment to treat everyone. Soon, I may have to decide who gets life-saving treatment and who dies.
This grim scenario is something no physician should ever have to face. Unfortunately, physicians in other countries have already been forced to. In Italy, physicians are practicing “wartime” medicine, deciding who gets precious resources based on their likelihood to recover. They have found themselves in this horrible position because their medical system has been overwhelmed by the number and severity of cases. The results speak for themselves; Italy now has more coronavirus deaths than any other country.
Fortunately, we are not there yet. But I fear we will be soon. Already, I have friends who work in New York City, telling me that their hospitals had to get ventilators shipped in from surrounding counties just so that they can keep all of their patients alive. While this is a great temporizing measure, this solution is not sustainable. Eventually, all of the ventilators will be in use. What are we to do then?
I’m horrified by the thought that I may have to decide who gets life-saving treatment and who doesn’t. I did not become a physician to play God. I became a physician because I wanted to help every single patient I possibly could. Now, I may have to sit back and watch my patients die because our health care system does not have enough equipment. How am I possibly expected to decide who gets life-saving care and who doesn’t?
I keep hoping someone will step in and give us official guidelines, but I hold no illusion that they will be forthcoming. What would those guidelines even look like? It is difficult, if not impossible, to even force my brain to think through the scenario. Do I base my decision on age? Mortality rates are highest among the elderly; perhaps it’s wasteful to give them ventilators. Should comorbid conditions factor into my decision? Those with heart and lung disease also have higher mortality rates; perhaps only those without chronic conditions should be allocated these precious resources. What if the family is with the patient and begging me to keep their loved one alive? Do I give that patient the ventilator over someone who came in alone?
The president and governors can declare states of emergency, but facing the awful possibility of an overwhelmed medical system is clearly beyond their expertise. This is, after all, the same government that has told me a bandana or a scarf constitutes adequate protection from coronavirus. If the day comes when we have to decide who receives care and who doesn’t, we medical professionals will face this nightmare scenario alone. Just as government officials are calling on us to fight this pandemic without proper protection, they will leave these hard, unpopular decisions to us. We will be forced to face the grief, confusion, anger, and probably malpractice suits of our patients and their families alone as we try to treat those that we can.
I did not sign up for this. No health care provider did. Asking me to make these decisions is asking me to turn my back on the sacred oath that defines my profession. Yet I lie awake at night wondering if I will have to. These extraordinary times may dictate it. To those that I will treat: Please know that I will do everything in my power to heal you and advocate for you. To my fellow health care providers: Stay strong. We will get through this. It will not be easy, but we will. And when we do, we will have to fight to make sure that we never find ourselves in this position again.
Gregory Jasani is an emergency medicine resident.
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