A legal way to reduce ventilator needs – advance health care directives

[swissaustrian]

I know this is a controversial topic. I have had family members in situations as described here. Please keep the discussion civilized. Thank you.

The bottleneck in the current intensive care treatment of corona patients is ventilators. Even more extreme measures like pulmonary bypasses, i.e. the oxygenation of the patients’ blood outside of the body and the shutdown of the lungs, are rarely discussed, but seem to be in use on occasion. This text will focus on ventilator use as a legal barrier for the consensual termination of treatments.

The chance of survival for a ventilator patient with covid-19 is around 40%. Even if the patient survives, chronic lung damage is likely. Treatments usually last for more than a week and intensive care occupancy stretches out much longer than for other ventilator conditions.
The risk group for such severe outcomes is clearly defined. Corona epidemic deaths have almost exclusively been limited to people with serious pre-existing conditions (hypertension, diabetes, cardiovascular, respiratory) and very high age. The first 2500 deaths in Italy had 99.2 % pre-existing conditions and a median age of 80.5 years. None under 30 died at all.

The extreme measures that governments are taking to slow the spread and therefore ultimately ventilator demand are also meant to buy time to acquire more ventilators. Unfortunately, though, some members of risk groups are not participating in the social distancing and hygiene measures with the necessary diligence. Some are disregarding them altogether. It seems that some are consciously taking a chance at getting seriously ill. They have lived their lives and they know that they will die of something and they are accepting that corona might be the cause. That is their good right.
However, if they are gambling with death, they might also be willing to preemptively forego their option to be hooked up to a ventilator. This is perfectly legal in most countries via an advance health care directive. After such an opt-out, their treatments would be limited to palliative care, thereby reducing the demand for ventilators. Advance health care directives are also reducing the responsibility and frequency of physicians to make life or death decisions. Some countries have legalized assisted suicide and such options are also the patients good right, provided they are consciously taking the decision to die.

The following actors might be willing and able to finance the legal costs of setting up an advance health care directive: the potential patients, their health insurance, charities, the government.

Finally, a caveat: there is potential for abuse. Highly suggestible and mentally impaired people might be coerced into forgoing their rights and strong legal and practical safeguards (witnesses, documentation, transparency etc.) have be in place to prevent that and in the worst case, to punish abusers after the fact/death.

[swissaustrian]

This is what I am talking about in the OP

https://www.dailymail.co.uk/news/art...entilator.html
Woman, 90, dies from coronavirus in Belgium after refusing a ventilator and telling doctors: 'I had a good life, keep this for the younger'

and also interesting:
the family were baffled as to how their mother could have contracted the virus as she had stayed at home and was complying carefully with lockdown measures.

may she rest in peace.

[sparebulb]

I'm perfectly fine with a person refusing to be placed on a ventilator.

However, I don't necessarily find this to be a noble act unless there was indeed a critical local shortage of ventilators.

I would like to know what information was presented to her to help her make her decision.

[swissaustrian]

I'm perfectly fine with a person refusing to be placed on a ventilator.

However, I don't necessarily find this to be a noble act unless there was indeed a critical local shortage of ventilators.

I would like to know what information was presented to her to help her make her decision.

I think the motivation is key.
I am currently working on an information campaign that provides an unbiased account of what it actually means to be hooked up to a respirator. I think people should make those decisions on the prospect of their personal chance of survival and long term complications, not on the supply or greater good reasoning.
My parents have have living wills with exclusions of respirators for a long time.

[Brian4Liberty]

I think the motivation is key.
I am currently working on an information campaign that provides an unbiased account of what it actually means to be hooked up to a respirator. I think people should make those decisions on the prospect of their personal chance of survival and long term complications, not on the supply or greater good reasoning.
My parents have have living wills with exclusions of respirators for a long time.

Don't you mean ventilator in the OP?

[swissaustrian]

Don't you mean ventilator in the OP?

thanks. you are right. my native language uses the term respirator for the english meaning of ventilators

[euphemia]

My daughter and I talked about this yesterday.

[Brian4Liberty]

thanks. you are right. my native language uses the term respirator for the english meaning of ventilators

Updated the title for you.