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Working Well

Triage and the Morality of ‘Playing God’

Religion and morality aside, this is more about the ethics of medicine. To what degree should professionals get to choose who they treat?

I drove to New Orleans with my sister and her pit bull in December. Fourteen hours on the road from Chicago, so a lot of our time was occupied by podcasts. I can’t get one of them out of my head after reading about one of the big health-care related developments in the news recently.

I’m talking about a rule that medical professionals can opt out of performing certain procedures for moral or religious reasons. Many people have written about this. (See Here, here and here.) Religion and morality aside, to me this story says more about the ethics of medicine. To what degree should professionals get to choose who they treat?

I won’t go into the focus of other articles. After all, much has been written on this already. What the development did remind me of was a podcast that my sister introduced me to on our road trip, RadioLab’s “Playing God.”

This episode explored the concept of triage — the process of determining the priority of patients’ treatments based on the severity of their condition — in a very specific scenario. When Hurricane Katrina hit New Orleans in 2005, Memorial Hospital had too many patients and limited resources. They had to come up with a system to decide who got care and who did not. Essentially, these everyday medical professionals had to decide who lived and who died.

It also explored what one town did to establish triage rules just in case they’d be necessary at some point in time. A group of researchers wanted to come up with rules so that medical professionals did not have to create their own system on the spot in an emergency. They could just stick with the chosen triage plan instead and spend their time treating people instead of compromising with each other on a system and wasting valuable time.

New Orleans dog

Ringo the dog on the road to New Orleans. Photo by Andie Burjek

They came up with a system in collaboration with the public through something like a grim, futuristic town hall meeting. They gave these people the scenario: a deadly flu hits the American public. There’s a limited amount of vaccines available. The also gave these people guidelines for how they can choose who gets care and who doesn’t. You can only base the decision on medical factors and not issues of race, religion, gender, nationality, citizenship status, criminal record, etc.

For example, the people who are most likely to survive would be selected to get the vaccine (leaving behind the sickest). Or, choose the people who have the most years to live if they survive (leaving behind the sickest and the oldest). Each with comes with its own set of problems but also has its own set of pros.

No solution would be perfect, but a solution based on medical factors rather than non-medical factors was the best option.

My takeaway: my first reaction was that people who have committed violent crimes like murder, domestic abuse or assault should not be able to get care in this scenario. I adamantly believed that, and then the more I thought about it, the more I realized that I could never be a medical professional. Because why should I let morality get in the way of giving people medical care? Isn’t that the point of the Hippocratic oath, that it comes down to medical factors and you don’t let your own personal beliefs get in the way of treating a patient?

To quote from an opinion piece by Dr. Daniel Summers, a pediatrician in New England:

Because many people justify their bigotry against gender and sexual minorities in religious terms, this new division is quite alarming news for LGBTQ people. The creation of this division appears to open the door for medical providers to, for example, refuse to provide gender confirmation treatment for trans people, or refuse to treat children with same-sex parents.

One attendee at the ceremony announcing this new division was Sara Hellwege, a nurse-midwife who sued in 2014 after being denied a job at a Florida health center. The reason she didn’t get the job? She admitted that she would refuse to prescribe birth control pills because of her religious beliefs—and prescribing birth control pills was part of the job she applied for.

She had no business seeking the position in the first place.

David Gorski, a surgeon and editor of the website Science-Based Medicine, expressed the views of many medical providers, myself included, when he tweeted that “physicians who refuse to treat certain patients based on their religious beliefs are in the wrong profession and should never have become doctors in the first place.”

“Doctors are people; people love and hate, and have biases and blind spots,” Zackary Berger told me. Berger is an internal medicine physician in Baltimore and treasurer of Clinicians for Progressive Care. “On the other hand, as professionals and as members of the US health care system, doctors must treat everyone no matter who they are.”

MORE HEALTH AND WELLNESS GEMS

I’m trying out this section where I share wellness-related stories caught my attention in the past week. There’s so much to write about in this space that it’s impossible to do a deep dive on every topic. Hope this helps you learn a little more about what’s going on in the wellness world!

Bold Collaboration: While the Amazon-Berkshire-JPMorgan health care company collaboration is the most ambitious employer effort to date to control health care expenses, Zack Cooper, an economist at Yale School of Public Health, was quoted as saying it’s “a bit arrogant to think that three big firms are going to come in and re-invent health care,” according to a Chicago Tribune article.

The three companies’ joint venture brings up some data privacy concerns. Amazon already has access to a lot of people’s data. What happens if they get access to health care data? There’s “a constant tension between the pros of predictive health care data and the challenges,” according to the Washington Post.

Stand Up-Sit Down: There’s a lot of hoopla in the wellness world about the health benefits of standing desks. But the research on this topic is still very young. Research should acknowledge that there could be downsides to prolonged standing, according to the Los Angeles Times. “We talk a lot about the need to avoid sitting for too long, and I think the interpretation of that for some people is, ‘OK, let’s just stand. But the solution is not just to stand all those hours,’ ” said one researcher.

Getting Schooled: Providing child-care benefits to educators can be good for school districts, according to Education Week. Teaching is “actually not as family-friendly a position as one might imagine,” said one source, noting the lack of flexibility in many teachers’ schedules.

Andie Burjek is a Workforce associate editor. Comment below or email editors@workforce.com.