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Impossible ethics of pandemic triage + Dogfight for PPE: withdrawal from Big Gov

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Dogfight for PPE as cold turkey withdrawal from Big Gov felt
https://www.vox.com/2020/4/4/21208122/pp...ion-states

EXCERPT: . . . After President Donald Trump declared the coronavirus a national emergency in March, he instructed governors to order their own ventilators and other PPE [personal protective equipment], saying the federal government is “not a shipping clerk.” Trump added the administration will “help out wherever we can,” but state leaders say that current efforts aren’t enough — and that the Trump administration’s refusal to coordinate PPE distribution has forced them to compete with one another for supplies.

“It’s like being on eBay with 50 other states, bidding on a ventilator,” said New York Gov. Andrew Cuomo in a press briefing on March 31. “We the states are trying to actively get every piece of PPE that we can. We’re bidding against one another, and in some cases, the federal government is taking priority,” Michigan Gov. Gretchen Whitmer said on CNN’s State of the Union.

A number of governors — including Massachusetts Gov. Charlie Baker — have said they’ve seen orders for masks and other needed equipment canceled because the federal government outbid them. This has led to some finding creative ways to disguise their orders to mask them from the Trump administration.

[...] Some workers are wearing bandanas and scarves as an alternative to masks, fashioning gowns from trash bags, and rationing or even reusing medical equipment. The federal emergency stockpile is nearly depleted and “the supply chain for PPE worldwide has broken down,” a DHS official told the Washington Post. The situation is dire, and states, especially those with increasing numbers of coronavirus cases, are desperate for supplies... (MORE - details)



The Impossible Ethics of Pandemic Triage
https://www.thenewatlantis.com/publicati...mic-triage

EXCERPT: . . . Most physicians are not trained as wartime medics. We have never before faced these battlefield triage decisions. And with the coronavirus pandemic, there are additional ethical complications. [...] Health care workers certainly have a duty to care for the sick. Just as firefighters run into burning buildings while others run away, so also we treat contagious patients while others are socially distancing.

But just as firefighters never signed up to run into burning buildings in their boxer shorts, so also doctors and nurses did not sign up to treat infectious diseases without basic personal protective equipment — gowns, gloves, and masks that cost pennies apiece yet somehow are in short supply. When this PPE is gone, and doctors lack even the most basic barriers against infection, should the 70-year-old physician have to stay in the game? What about the 28-year-old pregnant medical resident who has an elderly immunocompromised grandfather living at home?

Suppose during this crisis we stretch the duty to treat contagious patients to heroic proportions. This is part of the physician’s job, so it is all hands on deck. [...] Should we then pull Mrs. Jones off the ventilator and offer it to the infected physician, who after all acquired Covid-19 while on the front lines heroically risking her own health to care for patients? If we are not convinced by the argument from reciprocity (that she deserves some reward for these efforts), what about the “multiplier effect”? If our central ethical principle under crisis conditions is to save as many lives as possible, it seems plausible that saving this ICU physician — if she recovers and returns to the fray — could help save the lives of more patients. Doctors are in short supply and cannot be easily replaced.

Okay, fine — perhaps we can prioritize doctors, all other things being equal in terms of prognosis. But many other workers are also critical to the pandemic response. Perhaps we can “replace” food service workers and janitors — as distasteful as it is to put it in those terms and think of our fellow human beings in that way — but what about the lead scientist on a project to develop a coronavirus vaccine? Or the police chief of New York? Or any police officer or firefighter, for that matter? What about a priority nudge for pregnant patients on the basis of this same multiplier effect? How should we draw the line around this category of “critical workers” or others who can get a bump up the triage list? (MORE - details)
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