“Patients showing substantial clinical deterioration that portends a very low chance for survival will have critical care discontinued.” Such is a new "rule" quietly issued OVER THE WEEKEND by the New Jersey Department of Health concerning who gets care when the healthcare system is stressed . . . as it is now.
State officials have issued new emergency triage guidelines on the use of scarce hospital resources for critically ill patients, should the public health emergency over the coronavirus worsen.
The rules would mean that patients would be prioritized over whether they receive resources in scarce supply, most specifically ventilators.
Health Commissioner Judith Persichilli said the triage plan would be used to help determine whether the ongoing provision of critical care resources were justified for individual patients and would only occur in a worse-case scenario.
“These triage guidelines are intended to be the last resort. We hope and have planned that they will not be needed,” she said.
The rules over withholding of care would only kick in if a hospital is operating under a crisis standard of care, if a public health emergency is declared, and if critical care capacity is or will be shortly overwhelmed — despite taking all appropriate steps to increase the surge capacity to care for critically ill patients, according to Persichilli.
According to the guidelines that were issued over the weekend, triage teams for each hospital would use priority scores based on such issues as a patients’ likelihood of surviving to hospital discharge and the presence of a severely limited life expectancy — even if the patient survived the acute critical illness.
The triage guidance said “patients who are more likely to survive with intensive/critical care are prioritized over patients who are less likely to survive with intensive care/critical care. Patients who do not have a severely limited life expectancy are given priority over those who have such advanced conditions that they have a very limited life expectancy even if they survive the acute critical illness.”
The guidelines said all patients will be eligible to receive critical care beds and services regardless of their priority score, “but available critical care resources will be allocated according to priority score, such that the availability of these services will determine how many patients will receive critical care. Patients who are triaged to not receive ICU/critical care beds or services will be offered medical care including intensive symptom management and psychosocial support.”
Patients would also be reassessed through the emergency.
“Patients showing improvement will continue to receive ICU/critical care services until the next assessment,” the guidelines stated. “Patients showing substantial clinical deterioration that portends a very low chance for survival will have critical care discontinued.”
The rules talk at length about the "ethics" of depriving a person of life-sustaining health care, but nowhere do they talk about the Constitutional issues.
No person can be deprived of life, liberty or property without due process of law. The State Department of Health, by promulgating these rules, is literally forcing hospitals to act as agents of the state; and that immediately implicates the Constitution.
The New Jersey Department of Health cannot deprive any person of their liberty - in this case to purchase life-saving health care - without due process of law. Yet this new "rule" will do exactly that. Moreover, it will do so at a time when a person is least able to seek legal remedy to assure their rights. In the time it takes to attempt a legal remedy, the withholding of care is quite likely to result in the death of the person involved, making their legal efforts moot.
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