Doctors Should Not Have to Decide Who Lives or Dies
By Abraham Graber
Flashes of red and blue light reflect off the wet pavement as the ambulance speeds to the hospital. In the back of the ambulance, it’s your parent or maybe your grandparent—their excitement at finding toilet paper in stock crushed by the weight of a hydroplaning vehicle. You get the call and rush to the hospital but are turned away. In the world of COVID-19, visitors are not allowed.
Inside, the hospital is overrun. Providing your loved one the respirator they need would require letting someone else die. Your loved one is no longer young, and scarce healthcare resources are not spent on the old. Without friends or family by their side, your loved one breathes their last.
This story is now all too real. Hospitals are denying lifesaving care and turning away visitors. In these times, there is no avoiding unpleasant decisions. But we can choose who makes those decisions.
There is a world of difference between the ethical rules that govern the care of patients and the ethical rules that govern public health. Clinical ethics prioritize each individual and leave little room for utilitarian calculations. By contrast, in public health ethics, the value of individual lives is overshadowed by the needs of society.
A doctor cannot deny a patient lifesaving care without breaking the promise to heal. A doctor cannot force a patient to die alone, separated from friends and family, without breaking their promise to help. And even well after COVID-19 is gone, the memory of broken promises will linger. What sick patient would go to a hospital that chose to deny their father life-saving care? Who would go to a clinic where doctors forced their mother to face her life-and-death struggle alone? And once our faith in our healthcare institutions is broken, how will we handle our ongoing health crises—obesity, diabetes, and opioid addiction—much less the next pandemic?
There are, however, institutions tasked with balancing the good of society against the good of the individual: the Centers for Disease Control and Prevention, the National Institutes of Health, and the National Institute of Allergy and Infectious Diseases. There are also institutions closer to home: local, county, and state governments. Each of these institutions is tasked with striking the balance between individual and societal interests. In the face of a pandemic, it is institutions like these—duly advised by medical and public health experts—that must step up and take the lead.
It is deeply uncomfortable to imagine the government making decisions about who will live and who will die. But in times like these, it is not a question of if these decisions will be made but rather who will make them. Healthcare providers should not carry this burden; they lack both the expertise and the ethical permission. And though federal and state agencies have the expertise, they are too far removed from the realities on the ground.
Input from public health experts, federal agencies, and healthcare providers should be heeded, but only local governments have both the mandate to balance individual and societal interests and, by the power of the ballot, the ability to be held reasonably accountable for their decisions.
When there are not enough ventilators to go around, there is no way to avoid deciding who will die. We can, however, control who makes the policies that will determine who is given a chance to live. This decision cannot be left in the hands of our doctors and our hospitals.
Abraham Graber is associate professor and director of the medical humanities in The University of Texas at San Antonio Department of Philosophy and Classics. His forthcoming publication, titled “Plantinga redux: Is the scientific realist committed to the rejection of naturalism?” is due this year in the journal Sophia.