When COVID-19 Forces Ugly Decisions


As morgues in Arizona and Texas begin to overflow into refrigeration trucks and the number of Americans hospitalized nears a record high, COVID-19’s toll on Americans–– and American hospitals–– is reaching catastrophic proportions. When Italy was facing the worst of its pandemic experience, Italian doctors were forced to choose who would receive the scarce resources necessary for survival (typically the young and healthy). Now, some American doctors are confronting the difficult ethical decision with an equally difficult solution: councils that many refer to as “death panels.”

Starr County Memorial Hospital is a small hospital in rural Texas with already limited resources; meanwhile, the county faces a COVID-19 infection rate of approximately2.4% (compared to the national rate of 1.6%). The hospital, therefore, elected to institute a committee responsible for screening incoming COVID-19 patients for their expected ability to survive. According to Starr County Memorial president Jose Vasquez, the committee’s role is to determine “who has a better chance to use, in a beneficial way, all of the resources,” versus someone who “because of chronic medical illness does not have the chance to survive.” Those who fall in the former category are admitted for care, while those who fall into the latter category may betransferred to other counties or states, winding up “thousands of miles away dying alone in a hospital”.

While COVID-19 patients admitted to the hospital are by no means guaranteed survival–– a recent study found that patients placed on ventilators still face a mortality rate of about 30-50%–– the essential responsibility of Starr County Memorial’s committee is to determine the certainty of an individual’s death. The premise of hospitals deciding who dies or lives is understandably raising ethical alarms, but just how ethically dubious is this “death panel”?

From the rights approach to ethics, which prioritizes maintaining the rights of all parties involved, the hospital is certainly infringing on the right to healthcare, and possibly right to life, for the elderly and chronically ill. Doctors don’t have the option to accept everyone when resources are spread so thinly; however, there simply isn’t enough equipment to keep all patients alive. That being said, choosing the lives worthy of saving has its own complications–– for Vasquez, the utilitarian approach, which prioritizes the option that allows for the greatest balance of good, takes precedence. He rationalizes choosing to treat the young and healthyby maintaining that “we need to maximize the resources we’ve been given… [by using] scarce resources on who has a better chance of survival”.  At what point, however, do hospitals bear the responsibility of the deaths of those denied care? Is there a better or more ethically sound way to administer care?