At 20:42 20/03/2020, Thomas Cox wrote:
>Obvious problem: Some human has to issue an order to remove a
>patient, and another human has to actually withdraw the life-saving
>intervention. For many nurses/doctors those behaviors would mean
>killing a patient to benefit another patient.
For a start, I think we're talking about two different
things. Firstly, in the face of a situation in which there are fewer
ICU beds available than the number of patients who would ideally
occupy them, some sort of up-front prioritisation has to happen,
essentially giving the beds to those most likely to benefit from
them. If that decision (or, at least, assistance with that decision)
can be better made by a machine than an unaided human, then that
would surely be the way to go?
However, once a patient has been put into an ICU bed (and 'intensive
care' commenced) it becomes much more difficult and, other than in
the most extreme of circumstances, I don't think that ICU treatment
would be withdrawn from someone already receiving it if it were felt
that the result would very probably be their death (i.e. your
"killing a patient to benefit another patient"). However, I don't
think that the article was suggesting that - but, rather, was merely
saying that one of the possible approaches was to "... discharge
(from ICU) patients who were the least likely to be worse off in a
general ward to make room for new ones". That's very different from
prematurely discharging a patient from ICU when one knows that one
will probably thereby 'kill' them.
Maybe resources are so good in your country that it doesn't usually
happen, but if you were over here you would be very familiar with
people being moved from ICU to a ward sooner than was clinically
ideal (i.e. 'prematurely') because a 'more needy' patient needed the
ICU bed. When I was involved in the running of a 4-bedded Coronary
Care Unit (which served a population of about 250,000) I had to do
that most days - a gamble/calculated risk, yes, but an approach which
hopefully resulted in the greatest number of survivors.
Kind Regards,
John
----------------------------------------------------------------
Dr John Whittington, Voice: +44 (0) 1296 730225
Mediscience Services Fax: +44 (0) 1296 738893
Twyford Manor, Twyford, E-mail: [log in to unmask]
Buckingham MK18 4EL, UK
----------------------------------------------------------------
******************************************************
Please note that if you press the 'Reply' button your
message will go only to the sender of this message.
If you want to reply to the whole list, use your mailer's
'Reply-to-All' button to send your message automatically
to [log in to unmask]
Disclaimer: The messages sent to this list are the views of the sender and cannot be assumed to be representative of the range of views held by subscribers to the Radical Statistics Group. To find out more about Radical Statistics and its aims and activities and read current and past issues of our newsletter you are invited to visit our web site www.radstats.org.uk.
*******************************************************
|