Health Care and the Utilitarian Calculus

As I have said before on Breakpoint, much of the hype and even hysteria surrounding the H1N1 flu strain is unwarranted.

That’s not to say that the swine flu’s potential impact isn’t devastating—it is, but not in the way cable news would have us think.

And now the Florida Department of Health has issued a set of guidelines that instructs hospitals on what to do “if the state is overwhelmed by [H1N1] cases.”

The guidelines recommend that hospitals bar “patients with incurable cancer, end-stage multiple sclerosis and other conditions from being admitted to hospitals.” Another “recommendation” is that doctors “remove patients with poor prognoses from ventilators to treat those who have better chances of surviving.”

To facilitate this culling of the herd, the guidelines “suggest” that “intensive care unit patients and those using ventilators to be reassessed after 48 to 72 hours.” Those who have gotten sicker “would be taken off the machines or discharged from critical care” and replaced by those “who may have a better chance of survival.”

Not surprisingly, the Department of Health has not “publicized the guidelines or solicited input from the general public.” Not a bad strategy, given that Florida is packed with elderly retirees who may be less than thrilled by the news that the state proposes to make it easier to deny them emergency medical care.

Superficially, the guidelines resemble what on the battlefield is called triage. But that resemblance is just that—superficial. On a battlefield or in an emergency, medical personnel make agonizing decisions about whom they can and cannot save. No one is excluded before the actual emergency.

Here, the distinction is between those they will and will not save. It’s designating, in advance, those groups whom are regarded as expendable. And, as ethicist Wesley J. Smith pointed out, removing people from ventilators goes beyond triage principles to “indiscriminate rationing.”

Actually, there’s nothing indiscriminate about it. In a drill for a similar set of guidelines in Utah, a physician told a mother that her daughter with cerebral palsy could not be admitted to the hospital. He told her that “our list is our list.” function fbs_click() {u=location.href.substring(0,location.href.lastIndexOf(‘/’));t=document.title;‘’+encodeURIComponent(u)+’&t=’+encodeURIComponent(t),’sharer’,’toolbar=0,status=0,width=626,height=436′);return false;}

That’s why Smith is rightly concerned that guidelines like Florida’s could easily degenerate into judgments about the quality of life, age discrimination, and disabilities.

The triage consistent with Christian moral principles acknowledges that you try to save everyone, even if you can’t. But what Florida is proposing is a utilitarian calculation that seeks to do, in their words, “the greatest good for the greatest number,” by excluding the most vulnerable members of society. That’s the utilitarian formulation which led to the horrors of eugenics.

Christianity teaches that all life is sacred from birth to natural death. Florida, however, has already decided that some lives aren’t worth saving even if natural death is years away.

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