If I were thinking rationally amid the coronavirus crisis, I might not write this column. But onward I forge, with uncomfortable thoughts sometimes my literary companion.
In the flood or shall I say Tsunami of stories about the very real and menacing threat of a massive outbreak of COVID-19, I’ve read and thought about the ethical dilemma of deciding who should, and who shouldn’t receive life-saving treatment. This scary scenario has played out in Italy.
Should younger victims receive care over older ones in light of limited equipment and medical professionals?
Should patients, perhaps many with underlying medical ailments, who are failing to recover, be abandoned to protect doctors and nurses facing infection, again due in part to the nature of the ventilator procedure?
These ethical conundrums are not new. They just are more pronounced now as the cases mushroom in New York City, Washington State and now Maryland. Lack of preparation for an epidemic in terms of protective equipment, respirators and, yes, ethical considerations, are afflicting our currently fragile nation.
The country is operating on wartime footing without a foundation of prior readiness training. Our doctors and nurses, not to speak of government leaders, are coping with a severe emergency.
Ethicists serve a valuable service in normal times, let alone now. As this virus spreads, creating life and death situations on a daily, if not hourly basis, I worry about decisions giving professional caregivers God-like power.
What I do believe is that families must have a voice in the decision-making process, regardless of the urgency of the decision. It cannot be otherwise, though some may disagree. We cannot ration care without soulful thought.
Some might disagree: if we’re fighting a war, then human sacrifice is sadly necessary.
Darwinian decisions—who is best able to survive, whose years to live provide more value to society, who is “better” than someone else based on physical and mental health—give me pause. Emotion and rational thinking collide.
It’s entirely possible, if not probable, that my perspective as a 74-year-old skews my perspective. How couldn’t it?
Lack of preparation has created the conditions for life and death decisions, pitting the young against the old. And, again, if we are sticking to the wartime scenario, fairness and compassion may be casualties.
If this is true, we are doomed to determine the value of life through subjective benchmarks. The young person has far more years to contribute to our community; older folks have lived full lives. They’re no longer playing on the first team. Their usefulness is diminished due to lack of longevity and declining health.
A good friend, when discussing this fraught subject, asked me: how would I choose between him, whom I’ve known for 64 years, and my 40-year-old daughter in deciding who should receive life-saving care, and who shouldn’t, if both required immediate medical intervention amid a shortage of ventilators or maybe even beds?
Readers might say that my daughter would receive top priority. Easy decision, right? Family over friendship is a no-brainer.
But I would be compelled to choose between a friend who was almost family and my daughter, who is an inextricable part of my being.
What bothers me is that doctors and families would face no-win predicaments because we as a country didn’t prepare for the inevitable. Scientists like Tony Fauci and business tycoon and philanthropist Bill Gates have predicted the vast catastrophe now demanding our attention and changing our lifestyle.
If we are in deadly combat with a potentially fatal virus, then it’s reasonable that our nation should aggressively adopt a posture that mandates the rapid production of ventilators, masks and protective equipment.
Deaths are mounting in New York State. COVID-19 is spreading. Social distancing and hand-washing perhaps have slowed the pandemic.
I well understand that a 74-year-old such as this writer has limited time on earth. Under the current circumstances, my life is less valuable than someone half my age. That may be true. It also is shameful that these words must be voiced.
The coronavirus forces an examination of ethical issues that beg for straight-forward answers. There are none.
Nor should there be.
P.S. For interested in this subject should read this timely article from the Washington Post yesterday.
Columnist Howard Freedlander retired in 2011 as Deputy State Treasurer of the State of Maryland. Previously, he was the executive officer of the Maryland National Guard. He also served as community editor for Chesapeake Publishing, lastly at the Queen Anne’s Record-Observer. In retirement, Howard serves on the boards of several non-profits on the Eastern Shore, Annapolis and Philadelphia.