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How should healthcare be distributed when hospitals are overwhelmed?


A sign for washing hands is seen during a news media tour of quarantine facilities for treating the COVID-19 coronavirus at a hospital in Montreal March 2, 2020. CNS photo/Christinne Muschi, Reuters

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New York City, N.Y. (CNA) -- As there are concerns over the ability of the healthcare system to manage the coronavirus pandemic, discussions are being had over what criteria should be used if healthcare must be rationed.

In Italy, where the virus has hit particularly hard, some doctors have said they have had to overlook older patients to focus on younger ones who are more likely to survive.

And in the UK some doctors have said they may have to prioritize care for those patients with better chances of surviving.

As these conversations are being had, CNA spoke via email March 16 with Charlie Camosy, an associate professor of theology at Fordham University, about what principles should be used as doctors might face such choices.

Among Camosy's research interests are bioethics and distributive justice. Among his works are ''Too Expensive to Treat? Finitude, Tragedy and the Neonatal ICU'' and ''Resisting Throwaway Culture: How a Consistent Life Ethic Can Unite a Fractured People."

Q. What principles should be used in deciding how to distribute limited treatment for coronavirus?

A. The first thing to say is that there are virtually no universally agreed-upon principles to do this -- excepting, perhaps, the idea that health care providers, first-responders, law enforcement, and others primarily responsible for the day-to-day functioning of the polity should get priority.

Beyond that, there is tremendous disagreement -- at least in the culture at large. What one believes about this largely comes from their first principles related to what they believe in their hearts and souls about the good, true, and beautiful.

Catholics, of course, have these principles ... and they differ especially from the utilitarian mindset that dominates so much of secular ethics and medicine today. We serve the most vulnerable first. Those people are Christ to us in a special way and we will be judged according to how we treat them. We don't think about, say, how long they might stay on a ventilator versus how long someone we might encounter next week might stay on a ventilator. We also don't think about how long they might have to live if the treatment is successful versus how long other someone we might encounter next week might live if their treatment is successful.

It makes sense, especially in a triage situation, to treat those first who are most likely to benefit from the treatment. And there may be a disproportionate number of younger people in the former category. But that is not the same as deciding that we ought to prefer the young to the old because they have longer to live. Some of the ways very public figures have downplayed the threat by talking about it mostly affecting the old have been disturbing. As soon as a Catholic hears that, we should be outraged and leap to the defense of this already marginalized population, which bears the faith of Christ in a special way.

Q. You said in a recent Twitter thread that many providers are 'uncritically utilitarian' in rationing. How exactly? By using the Quality-Adjusted Life Year (QALY) model?

A. Well, I think the QALY model reinforces something that was already there. Scientists and medics, in addition to being disproportionately secular, have absorbed a utilitarian mindset which probably ultimately comes down to solving an equation. While that might feel better than living in the uncertainty and messiness of Christian ethics, the decisions about how to handle what is coming our way are too complex to think about this way.

Q. Do you believe that "help those who can likely benefit from treatment first" is a good principle?

A. I do.

Q. Could you address what Catholics should do in their daily lives amid coronavirus to practice the Church's social teaching?

A. The Church has been at its finest in plagues and pandemics. We need to live our principles now more than ever.

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