In The Doctor’s
Dilemma, a wonderful play by George Bernard Shaw, a renowned doctor Sir Colenso
develops a new vaccine for tuberculosis. With a severe shortage of resources,
the doctor can save only one patient. A young woman begs him to save her ailing
husband. And an older man, a friend of Sir Colenso’s is also in need of the
vaccine. This friend is an ordinary but good-natured man. Whereas the younger
patient is a talented artist, but is a womanizer, a person without morals. In
the long play, and longer preface (typical of Shaw), Shaw discusses the moral
issue doctors face at times: who should live and who should die?
*****
Corona virus has opened up hundreds of such issues. Do
governments have a right to lockdown people? And if so, for how long? Should
privacy be sacrificed in the name of safety? Should we download the
contact-tracing app that records our every move? Why do people hoard toilet
paper? Is it right to charge higher prices for products in shortage? Is it moral
for a government to stop all public transport? To close schools and lock children
indoors? Is it ethical to let online
workers earn their living, without supporting the off-line workers who have
lost their jobs and paychecks? Is it fair to let people in prisons be infected,
as they invariably will be? Vaccines must be tested on animals extensively
before humans. The urgency to develop a vaccine is tempting pharma companies
and regulators to short-circuit that. Can that be ethical?
Moral governments and ethical rulers (the few left
now) ask themselves these questions, and decide their strategies accordingly.
Medical issues are the most discussed ones. What Shaw
wrote is harsh reality today. In Europe, in America, and soon probably in India
and most African countries.
*****
Triage is the process of deciding the priority among patients
for treatment. In mass casualty incidents, such as the collision of two buses,
paramedics and doctors urgently need to decide who should be treated first and
why. Triage is common in wars where the injured and dying far outnumber the
doctors and medicines available.
Most developed countries have triage protocols in
place. Based on them, even in the USA, patients are now refused admission into ICUs.
In many cases, in order to care for a newly arrived patient, someone else’s
ventilator is removed. Patients are given colour codes (blue, red, yellow and
green) to specify the treatment they will or will not receive.
Imagine six patients arriving at your hospital: a 35 year old white man, a 57 year old black
woman, a 45 year old with AIDS, a healthy and wealthy 81 year old man, an 11
year old Asian girl, and Tom Hanks. All of them require a ventilator – you have
only one. While you are making your decision, a heavily pregnant woman arrives
outside the ICU.
Who do you put on the ventilator?
Tomorrow, I will discuss the existing protocols that
answer this question.
Ravi
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