Stay calm and practice medicine. It seems a lot is being said about the numerous ethical questions arising as Ebola rears its ugly head in the United States. Those who have never worked in healthcare may find it disturbing, but in truth, physicians, nurses, and administrators routinely discuss necessary measures versus heroic measures in a variety of circumstances. It would be more disconcerting if hospitals were not considering these matters seriously and prior to any real outbreak of the disease in North America.
When any infectious disease or pathogen emerges or re-emerges (like tuberculosis), a panel of medical personnel working in a given hospital system will meet to discuss best practices, personal protective equipment, and precautions that best serve the patient, personnel, and other patients likely to come into contact with an individual during triage or treatment. Based on the analysis of the team, specific protocols are then developed for all in the system to follow as it pertains to individuals diagnosed with the ailment in question. Often protocols are delivered by educators who travel unit to unit, starting with the emergency department and walk in clinics likely to first encounter such patients. In-service training is accomplished and all personnel must be trained in order to work within a unit treating individuals infected with the disease in question. This is not only common practice, but it is best practice. All personnel will know the ethical, professional, and personal rights, risks, and obligations they are accepting when treating infected patients.
It is being widely reported that CPR is on the table as a treatment to be withheld from Ebola patients. Numerous studies report between a 2-16% success rate with CPR. The lower end is for someone found in public or at home and attended by an amateur. Even in an ambulance or hospital, however, survival post CPR is still less than 20%. It is a heroic measure that is often ineffective. Even so, every effort is made to save lives unless the patient or the patient’s family has issued a DNR (do not resuscitate) order. In the case of Ebola, by the time a patient has lost a pulse, the end is very near. It may not be worth the risk posed to attending medical staff to engage in CPR given the likelihood of failure.
Dialysis, a practice whereby blood is manually cleansed by machines and re-introduced to the body, is another procedure under scrutiny. Although this procedure is undertaken all across the U.S. with diabetics and others in renal failure, its real effectiveness in treating Ebola cannot be determined. Data related to this treatment is simply not available as most Ebola cases do not occur where this treatment is even available. Again, by the time renal (kidney) failure occurs from Ebola, patients are quite critical. Hospitals and medical staff will have to use excellent judgment and discretion before undertaking the procedure as bodily fluids will most certainly be all over the machine and the port used to access the patient. Extreme caution will be necessary, but under proper protocols, dialysis may be a viable option for treating Ebola. The jury is still out on that.
The fact is, no matter what hospitals determine is adequate or appropriate, in the United States, even under Obamacare, that is still a decision for the hospital administration and medical staff to make. When the government intervenes at the protocol level, we will officially have socialized medicine in the U.S. The infamous “death panels” related to Obamacare are the latter. In the Affordable (ha) Care Act, language is actually present that puts government panels in place that can determine the age at which certain treatments will not be deemed appropriate to be covered by the plans. This language references dialysis, chemotherapy, CPR, surgery, and a number of other treatments that American patients could “age out” of. That is a far scarier proposition than not doing CPR on an Ebola patient.