A doctor gathers information from a driver arriving to get tested for COVID-19 at private laboratory Biomedica de Referencia, in the Lomas Virreyes neighborhood of Mexico City, Thursday, March 26, 2020. The new coronavirus causes mild or moderate symptoms for most people, but for some, especially older adults and people with existing health problems, it can cause more severe illness or death. (AP Photo/Rebecca Blackwell)

A doctor gathers information from a driver arriving to get tested for COVID-19 at private laboratory Biomedica de Referencia, in the Lomas Virreyes neighborhood of Mexico City, Thursday, March 26, 2020. The new coronavirus causes mild or moderate symptoms for most people, but for some, especially older adults and people with existing health problems, it can cause more severe illness or death. (AP Photo/Rebecca Blackwell)

VIDEO: How doctors in Canada will decide who lives and dies if pandemic worsens

Officials in several provinces have been developing guides so that doctors don’t feel alone

When there’s only one ventilator but two patients who need it, how should a doctor decide who gets the chance to survive?

Medical ethicists across the country are working to help frontline workers answer weighty questions should the COVID-19 pandemic overwhelm hospitals the way it has in northern Italy and New York City.

“These are not decisions we want to make,” said Dr. Timothy Christie, who convenes an ethics committee that gives advice on pandemic response policy in New Brunswick.

“The planning that people are doing right now, they’re doing the best to make it so we don’t end up there.”

On Wednesday, chief public health officer Dr. Theresa Tam warned that Canada’s health-care system could be deluged in each of Ottawa’s pandemic scenarios. The system is not designed to deal with a surge of COVID-19 cases, which could mean facing difficult decisions about how to allocate sparse resources, she said.

Since the novel coronavirus was first confirmed in Canada, officials in several provinces have been developing guides so that doctors don’t feel alone in making life and death decisions.

British Columbia’s ethical framework builds on work started during the H1N1 epidemic and Ebola crisis. It addresses specific ethical questions on everything from distributing personal protective equipment and ventilators to “decision making about who will get scarce treatment if that comes to pass,” Dr. Bonnie Henry, the provincial health officer, said last week.

“No single individual physician or clinician will have to make that decision on their own.”

In Ontario, officials have announced the formation of an “ethics table” led by the University of Toronto’s joint centre for bioethics.

Alberta is working on a framework too.

“The focus will be on ensuring as many patients as possible receive the care they need,” Tom McMillan, a spokesman with Alberta Health, said in an email.

In New Brunswick, clinicians will be given a principle to help them make decisions based on their expertise.

Christie’s committee is recommending a fundamental shift in the underlying principle that doctors use to make treatment decisions if there aren’t enough hospital beds and ventilators.

“In cases where resources are limited, we would allocate the resources to people for whom we think will have the best outcome,” said Christie, who is also regional director of ethics services for the Horizon Health Network, the province’s anglophone health authority.

“That’s fundamentally different than the way we’d do it in normal circumstances.”

Under normal circumstances, Christie said doctors ask patients what their goals are. A patient with terminal cancer might wish to spend one last Christmas with his family, and treatment plans can be adjusted to help reach that goal.

COVID-19 could create a scenario where using a ventilator to keep someone alive for an extra few months comes at the expense of another person’s life, he said.

The challenge is determining how you define outcomes when comparing patients.

“There’s a lot of debate about how you define the best outcome. Some people would say it’s the amount of life you could live,” Christie said. In other words, choosing to save the younger of two patients.

“We reject that approach,” Christie said.

A 20-year-old and a 55-year-old both have ”significant” amounts of life left, so the difference between them is not morally relevant, he said.

Age isn’t the only factor being debated by the New Brunswick committee as it considers how to avoid discriminating against someone who develops COVID-19 after all ventilators are already in use.

Rather than stockpiling ventilators in anticipation of future cases, Christie said they are advising that a new patient be assessed against those already being ventilated. If the new patient has a good chance of surviving, doctors could ethically end the treatment for another patient who isn’t responding, he said.

But an ethical framework won’t help doctors who have to decide between two patients with nearly identical outcomes.

“In that circumstance you have an arbitrary decision. It’s going to be tragic, it’s going to be heartbreaking and it’s going to be arbitrary — and there’s no ethical principle that all of a sudden can make it better,” Christie said. “That’s no one’s fault.”

Amy Smart, The Canadian Press

Like us on Facebook and follow us on Twitter.

Coronavirus

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Lisa Beare, the MLA for Maple Ridge-Pitt Meadows, was sworn in as a member of cabinet on Thursday, Nov. 26. (Special to The News)
MLA for Maple Ridge-Pitt Meadows has a new cabinet position

Lisa Beare is the new Minister of Citizen’s Services

Email your cooking questions to Chef Dez at dez@chefdez.com.
ON COOKING: Mulligatawny is tough to spell but a tasty soup

Chef Dez offers up his version of a classic soup

Emma Davison, one half of Golden Ears Cheesecrafters in Maple Ridge, reflects on running her business in the year of COVID-19. (Scott Saunders/Special to The News)
OUTLOOK: Buying local imperative to agriculture businesses

Farmgate companies adapt to survive during early months of pandemic

Natasha Brayshaw’s acrylic on paper called Snowy Magic. (Vicuña Art Studio/Special to The News)
Representatives of MK Illumination light up Memorial Peace Park on Wednesday. (Neil Corbett/THE NEWS)
Maple Ridge decorating for Christmas

Lights and decorations going up in the downtown

B.C. Health Minister Adrian Dix and provincial health officer Dr. Bonnie Henry update the COVID-19 situation at the B.C. legislature, Nov. 23, 2020. (B.C. government)
B.C. sets another COVID-19 record with 887 new cases

Another 13 deaths, ties the highest three days ago

Arthur Topham has been sentenced to one month of house arrest and three years of probation after breaching the terms of his probation. Topham was convicted of promoting hate against Jewish people in 2015. (Photo submitted)
Quesnel man convicted for anti-Semitic website sentenced to house arrest for probation breach

Arthur Topham was convicted of breaching probation following his 2017 sentence for promoting hatred

Langley School District's board office. (Langley Advance Times files)
‘Sick Out’ aims to pressure B.C. schools over masks, class sizes

Parents from Langley and Surrey are worried about COVID safety in classrooms

Cannabis bought in British Columbia (Ashley Wadhwani/Black Press Media)
Is it time to start thinking about greener ways to package cannabis?

Packaging suppliers are still figuring eco-friendly and affordable packaging options that fit the mandates of Cannabis Regulations

Join Black Press Media and Do Some Good
Join Black Press Media and Do Some Good

Pay it Forward program supports local businesses in their community giving

The baby boy born to Gillian and Dave McIntosh of Abbotsford was released from hospital on Wednesday (Nov. 25) while Gillian continues to fight for her life after being diagnosed with COVID-19.
B.C. mom with COVID-19 still fighting for life while newborn baby now at home

Son was delivered Nov. 10 while Gillian McIntosh was in an induced coma

B.C. Premier John Horgan, a Star Trek fan, can’t resist a Vulcan salute as he takes the oath of office for a second term in Victoria, Nov. 26, 2020. (B.C. government)
Horgan names 20-member cabinet with same pandemic team

New faces in education, finance, economic recovery

A new ‘soft reporting’ room is opening inside the Ann Davis Transition Society offices on Dec. 1, 2020 which is thought to be the first of its kind in B.C. (Ann Davis Transitional Society/ Facebook)
New ‘trauma-informed’ reporting room opening next week in Chilliwack

It’s a space for reporting domestic violence, sexual assault, or gender-based violence to police

The corporate headquarters of Pfizer Canada are seen in Montreal, Monday, Nov. 9, 2020. The chief medical adviser at Health Canada says Pfizer’s COVID-19 vaccine could be approved in Canada next month. THE CANADIAN PRESS/Ryan Remiorz
Health Canada expects first COVID-19 vaccine to be approved next month

Canada has a purchase deal to buy at least 20 million doses of Pfizer’s vaccine,

Most Read