It’s the trolley problem in real life:
In the chaos of New York City, where coronavirus deaths are mounting so quickly that freezer trucks have been set up as makeshift morgues, several hospitals have taken the unprecedented step of allowing doctors not to resuscitate people with covid-19 to avoid exposing health-care workers to the highly contagious virus.[1]
What if throwing the switch to divert the trolley has a seventeen percent chance of actually diverting the trolley? Okay, this is actually the reverse of that:
Alice Thornton Bell, an advanced practice registered nurse and a senior director at Advisory Board, a hospital consulting firm, said just under 17 percent of people who are resuscitated in a hospital survive long enough to leave it — and that is not based on patients with complex respiratory problems. “The chances of that working for a covid-19 patient are very slim,” she said.
“We will see a lot of deaths,” one doctor typed in a grim text Saturday explaining the shift in protocol, “but they will happen nevertheless earlier or later.”[2]
In New York City, where there are now more confirmed cases than there were in Hubei, China, by a considerable margin,[3] the hospitals are overwhelmed. There is a shortage of ventilators such that patients are having to share them.[4]
So my older sister is a head nurse at Elmhurst Hospital and it’s really as bad as they say. Bodies piling up. Refrigerator trucks for corpses.
Stay the fuck home.
Stop hoarding medical supplies.
I’m terrified for her, but also for all of us.
— 🌲 (@ilana_esther_) March 28, 2020
The mother of another nurse in the same hospital contracted COVID-19 and died of it, she couldn’t even go say goodbye to her own mother in the hospital where she worked.
This isn’t a joke. This isn’t a hoax. And we are on our own out here with the weakest of government support.
— 🌲 (@ilana_esther_) March 28, 2020
When people start going back to work because their selfish ruggd indvdulizm says, fuck it my money is my god, more doctors and nurses are going to die. We are already out of time.
— 🌲 (@ilana_esther_) March 28, 2020
I know the Post is garbage but that’s literally my sister on the cover with this hair raising headline and I’m just pic.twitter.com/5LBgTbBgE9
— 🌲 (@ilana_esther_) March 28, 2020
People don’t generally go into medicine with the idea they’re going to let people die. But imagine facing these dilemmas for a multitude of patients, where the decision to fight for the life in front of you, with that less than seventeen percent chance of success, may mean other patients’ conditions grow worse, meaning they may die:
“If I have a patient and they crash, I’m going to try to do my best to save them,” [Diana] Torres said. “I’m not sure what I would do if they told me to stop. I can’t imagine making that choice.”
One doctor at a major New York hospital described how he recently ended up trying to resuscitate a patient who stopped breathing despite an order not to do so from a senior physician.
The patient “was turning blue and we were literally watching him die,” the doctor recalled. He said that he was thinking the man was young and had a family.[5]
What’s being set up here is a feedback where trying to do the “right thing,” deontologically speaking, worsens the crisis from a utilitarian perspective. It means that because a practitioner made that decision on deontological grounds, s/he faces that same dilemma for more patients down the line, that is, if s/he does not become infected themself, removing them from the business of saving lives altogether.
It’s as if throwing the switch means not so much that you save five people tied to the trolley tracks, but rather that you maybe, with less than a seventeen percent probability of success, save the one, while the trolley lumbers on to five more. Not only that, but doing so endangers your own life such that you might not be able to act for those five people.
This cannot really be the “right thing.” But I wonder how we persuade people who mean to expend every effort to save those lives of that in the very moment when a patient is dying right before them.
- [1]Ariana Eunjung Cha et al., “Faced with a crush of patients, besieged NYC hospitals struggle with life-or-death decisions,” Washington Post, March 31, 2020, https://www.washingtonpost.com/health/2020/03/31/new-york-city-hospitals-coronavirus/↩
- [2]Ariana Eunjung Cha et al., “Faced with a crush of patients, besieged NYC hospitals struggle with life-or-death decisions,” Washington Post, March 31, 2020, https://www.washingtonpost.com/health/2020/03/31/new-york-city-hospitals-coronavirus/↩
- [3]Center for Systems Science and Engineering, “Coronavirus COVID-19 Global Cases,” April 1, 2020, Johns Hopkins University, https://coronavirus.jhu.edu/map.html↩
- [4]Ariana Eunjung Cha et al., “Faced with a crush of patients, besieged NYC hospitals struggle with life-or-death decisions,” Washington Post, March 31, 2020, https://www.washingtonpost.com/health/2020/03/31/new-york-city-hospitals-coronavirus/↩
- [5]Ariana Eunjung Cha et al., “Faced with a crush of patients, besieged NYC hospitals struggle with life-or-death decisions,” Washington Post, March 31, 2020, https://www.washingtonpost.com/health/2020/03/31/new-york-city-hospitals-coronavirus/↩