The NCBC and the Christ Medicus Foundation issued a joint press release on April 13, 2020.
Who lives and who dies with COVID-19? America’s health care workers on the front lines are already confronting this question as they work to save lives in unprecedented triage situations in our homeland. The situation will worsen in the coming days. Who is given lifesaving care in a time of limited intensive care capacity and rationed equipment is one of the greatest moral questions our nation has ever faced. How we respond is a reflection of our values, one that will define us forever.
We call for a national set of clear and ethical triage protocols that affirm the dignity of all people. Until then, we urge hospitals and health care professionals to adopt protocols that protect the vulnerable and reject discrimination. The principle of the equal dignity and value of every human life depend on it.
“The ethical principles guiding such protocols must reject utilitarian or value-laden assessments that extend beyond the crisis situation and enshrine the view that some lives have more value than others,” said Dr. Joseph Meaney, president of the National Catholic Bioethics Center (NCBC).
Triage scoring systems must reject:
- Discrimination on the basis of age or disability
- “Quality of life” assessments, which discriminate against the disabled and the mentally ill
- Long-term survival or “life cycle” or “length of years” (used in the widely adopted University of Pittsburgh model) metrics that are just a thinly disguised means of discriminating on the basis of age and disability
“I sit here in New York, the epicenter of the COVID-19 crisis. It is imperative to provide our exhausted healthcare heroes with the tools they need to be able to make true and sound ethical decisions to all patients in their care. I join together with the NCBC ethicists, and others, in asking that all people are treated equally and with the God-given dignity they deserve,” said His Eminence Cardinal Timothy Dolan, Archbishop of New York.
We urge hospitals and healthcare workers to use survivability as the litmus test for rationing care during triage. Anything more is stereotyping. Objective clinical criteria found in the Sequential Organ Failure Assessment (SOFA) scores or the Acute Physiologic Assessment and Chronic Health Evaluation (APACHE II) scores are ethical and clear protocols for determining survivability. Once decisions are expanded to include nonclinical factors and value judgments, discrimination and injustice inevitably ensue.
“A significant source of hope and joy in our current health crisis comes from recognizing and honoring our God given human dignity and joining together to love and care for one another, giving special care to those who are most vulnerable,” said Father James Bromwich, STL, MA, RN.
In the words of our Bishops, “Every crisis produces fear, and the COVID-19 pandemic is no exception. However, this is not a time to sideline our ethical and moral principles. It is a time to uphold them ever more strongly, for they will critically assist us in steering through these trying times.”
As our Surgeon General recently put it, this is our “Pearl Harbor moment.” It is not only our moment to save as many lives as our limited resources will allow, but it is also our moment to recommit to the foundational American principle that every American life has equal and inherent value. It the chance to re-establish our obligation to protect the poor, the marginalized, and the vulnerable, and to ensure that they have equal footing with the rest of society.
Health care workers risking their lives on the front lines have the right to operate under guidelines that leave them with a clear conscience, and every American has the right to protection against discrimination in health care. “As a critical care nurse, I empathize with my fellow health care workers as they deal not only with the physical work of COVID-19 patients, but with the stress of the intense ethical decisions they are being forced to make given the lack of resources and the high volumes of patients. Clear, concise ethical guidelines are desperately needed to help them navigate this unique healthcare crisis,” said Deb O’Hara Rusckowski, RN, MBA, MTS, and board member of the NCBC.
“A crisis that involves triage may strain our resources, but it cannot strain our values. We call on every hospital and healthcare center to act now to ensure that those rights are robustly protected and that the value of every human life is respected,” said Louis Brown, executive director of the Christ Medicus Foundation.
More resources available here:
- “Triage in the Perspective of Catholic Bioethics,” by The National Catholic Bioethics Center
- “Triage Protocol Guidelines,” by The National Catholic Bioethics Center
The National Catholic Bioethics Center, established in 1972, conducts research, consultation, publishing and education to promote human dignity in health care and the life sciences, and derives its message directly from the teachings of the Catholic Church.
The Christ Medicus Foundation is a Catholic 501(c)3 non-profit founded in 1997, dedicated to sharing the love of God in health care through defending religious freedom in health care and building a Christ-centered Catholic health care economy that serves the Church, the laity, and the poor and vulnerable.