As the nation faces a rising number of patients diagnosed with COVID-19, it’s become increasingly evident that one concern may outweigh all others — there may not be enough ventilators and life-saving drugs to supply everyone in need with them.
The team at the Institute of Clinical Bioethics at Saint Joseph's University, including Peter Clark, S.J., Ph.D. ‘75, professor of medical ethics and director of the ICB have been working closely with the institute’s 17 affiliated hospitals to address broader ethical issues that have come up due to the spread of COVID-19.
According to Clark, each provider is charged with developing its own protocols and procedures for care, but also must take into consideration any policies being developed by individual states.
“The problem is that the health systems are coming up with policies on allocations of services, but so is the state,” says Clark. “We have to adhere to the state guidelines, but those guidelines can only be looked at if the states’ governors activate them,” which has not yet been the case in the three states where ICB-affiliated providers are located.
At each hospital, triage teams have been tasked with making the tough decisions about rationing care, should the need arise. The teams consist of one critical care physician, one critical care nurse and one respiratory therapist. By moving the decision from the bedside physician to the triage team, the burden — and pressure — is lifted from the doctors dealing directly with patients, Clark says.
“Triage is based on a very clinical, complex scoring system called a SOFA score — Sequential Organ Failure Assessment,” says Clark. “These scores are based purely on symptoms and comorbidities [the presence of other conditions in addition to the patient’s primary condition], all in an attempt to make these decisions as objective as possible across the board.”
Transparency in the triage process is essential in ensuring that all members of the community know exactly what standards are being put into place, Clark says.
“As Catholic teachings tell us, each human life has inherently equal moral worth,” says Clark. “These systems and protocols help us to ensure that decisions are made based upon that ideology.”
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