When lifesaving medicines run low, hospitals have to choose which patients get a scarce drug. Ethicists historically have recommended giving the drug to the patient most likely to benefit or using a lottery.
Not any more. Pennsylvania hospitals are tilting the scale in favor of patients from “disadvantaged areas.” If you’re middle class, you’re toast. To “redress social injustices,” Pennsylvania is applying a “weighted lottery” statewide, to hike the odds that the scarce drug remdesivir for COVID-19 will be given to patients from poor neighborhoods.
Remdesivir is a medicine that speeds recovery and increases survival chances by 62 percent, according to its maker. If you can get it. Your zip code could literally mean the difference between life and death.
“This is all very new,” explains Douglas White, an ethicist at the University of Pittsburgh, who helped devise the weighted lottery. Some ethicists are urging other states to follow suit. If remdesivir runs short in South Carolina, the state will apply preference like the one in Pennsylvania, according to Dee Ford, a professor at the Medical University of South Carolina.
People need to speak out against this deadly scheme.
In the past, if many patients needed a scarce drug, deciding who got it involved only their medical conditions and likelihood of recovery. It’s a far cry from favoring patients from low-income areas.
The Greenwall Foundation, a medical-ethics group, advocates “mitigating health disparities” by prioritizing who gets remdesivir and future COVID-19 therapeutics. So do researchers at the University of California, San Francisco.
It’s common sense that when a COVID-19 vaccine becomes available, it should be distributed to disadvantaged neighborhoods first to prevent the most cases. Residents there are more likely to live in crowded conditions, be unable to socially distance and work on jobs in mass transit and grocery stores that expose them.
But caring for hospital patients is a different matter. Equal treatment is the only morally acceptable rule. Patients need to trust that their caregivers are doing all they can. Families shouldn’t have to wonder if their zip code had something to do with why Dad died in the ICU.
This isn’t just about remdesivir. Hospitals face shortages of lifesaving drugs often, including the widely used vincristine for childhood cancers.
Allocating scarce medical resources, including kidneys and livers, based on economic criteria is an idea gaining steam. The Organ Procurement and Transplantation Network floated a proposal in January to require transplant candidates to provide household income on their applications, as a first step toward increasing the number of transplants offered to patients with low “socioeconomic status.” The proposal has provoked considerable controversy from other transplant advocacy groups.
Academics are using the pandemic as a launching pad to push their redistributionist agenda. But it isn’t what the public wants. A majority of people say a hospital’s goals should be saving the most lives and treating people equally, a new poll shows.
Most states aren’t rigging the system. Yet. New York has so few patients hospitalized with COVID-19 that it recently sent remdesivir to Florida. Texas is reserving its supply for patients not yet on ventilators. Minnesota emphatically rejects socioeconomic preferences.
Even so, rationing against the middle class is likely to spread if left up to university medical ethicists, who are trying to keep it quiet.
The Pennsylvania lottery’s designers say they were inspired by a weighted lottery for oversubscribed charter schools that gave preferences based on address. But preferential treatment in hospitals, where it can literally determine who survives, would be even more divisive.
The ICU is no place for social engineering. It’s nothing short of frightening. The public needs to stop it now.
Betsy McCaughey is a former lieutenant governor of New York.