Key Focus

  • We are working to update our guidelines," a Department of Health spokesperson wrote.
    At Harvard, Truog, who supports White's framework, has recently published articles in the New England Journal of Medicine and the Boston Globe to help prepare hospitals, doctors and the public for the decisions and outcomes he thinks they could be facing soon.
    That kind of forethought by specialists is important, White has argued, so that doctors facing a pandemic don't have to struggle with such dire ethical questions case by case
  • By contrast, the framework White and his team developed ensures no one is disqualified from critical care from the outset.
    "Everyone who is normally eligible for intensive care remains eligible in a public health emergency," White said.
    Several hundred hospitals around the country have adopted White's framework, he said
  • Typically, adult patients will stay in the ICU -- and on a ventilator -- for only three to four days, as one Connecticut doctor explained, but Covid-19 patients need them for up to two or three weeks, dramatically increasing demand.
    Truog said he worked all weekend helping hospitals develop policies that determine who receives intensive care during a public health emergency.


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High Level Topics

  • HOSPITALS
  • HEALTH
  • DOCTORS
  • GUIDANCE
  • High Level Abstractions

  • HOSPITALS(5, 0 Order)
  • ( HOSPITALS )(5, 0 Order)  top
  • ( HOSPITALS, HEALTH )(3, 1st Order)  top
  • ( HOSPITALS, DOCTORS )(2, 1st Order)  top
  • ( HOSPITALS, POLICIES )(1, 1st Order)  top
  • ( HOSPITALS, NEW_ENGLAND_JOURNAL )(1, 1st Order)  top
  • ( HOSPITALS, MEDSTAR )(1, 1st Order)  top
  • ( HOSPITALS, JOHNS_HOPKINS )(1, 1st Order)  top
  • ( HOSPITALS, ICU )(1, 1st Order)  top
  • ( HOSPITALS, HARVARD )(1, 1st Order)  top
  • ( HOSPITALS, FORETHOUGHT )(1, 1st Order)  top
  • ( HOSPITALS, COVID-19 )(2, 1st Order)  top
  • ( HOSPITALS, BOSTON_GLOBE )(1, 1st Order)  top
  • HEALTH(7, 0 Order)
  • ( HEALTH )(7, 0 Order)  top
  • ( HEALTH, DOCTORS )(3, 1st Order)  top
  • ( HEALTH, GUIDANCE )(3, 1st Order)  top
  • ( HEALTH, WELL-BEING )(1, 1st Order)  top
  • ( HEALTH, UNIVERSITY )(1, 1st Order)  top
  • ( HEALTH, TRUOG )(1, 1st Order)  top
  • ( HEALTH, TRIAGE )(2, 1st Order)  top
  • ( HEALTH, PENNSYLVANIA )(1, 1st Order)  top
  • ( HEALTH, ICU )(2, 1st Order)  top
  • ( HEALTH, PROVIDENCE_TRINITYCARE_HOSPICE )(1, 1st Order)  top
  • ( HEALTH, POLICIES )(1, 1st Order)  top
  • ( HEALTH, PITTSBURGH_MEDICAL_CENTER )(1, 1st Order)  top
  • DOCTORS(5, 0 Order)
  • ( DOCTORS )(5, 0 Order)  top
  • ( DOCTORS, TRUOG )(2, 1st Order)  top
  • ( DOCTORS, WELL-BEING )(1, 1st Order)  top
  • ( DOCTORS, TRIAGE )(3, 1st Order)  top
  • ( DOCTORS, AMERICAN )(2, 1st Order)  top
  • ( DOCTORS, VENTILATORS )(2, 1st Order)  top
  • ( DOCTORS, PROVIDENCE_TRINITYCARE_HOSPICE )(1, 1st Order)  top
  • ( DOCTORS, PALLIATIVE )(1, 1st Order)  top
  • ( DOCTORS, OBJECTIVITY )(1, 1st Order)  top
  • ( DOCTORS, NON-FRONTLINE )(1, 1st Order)  top
  • ( DOCTORS, NEW_ENGLAND_JOURNAL )(1, 1st Order)  top
  • ( DOCTORS, LOS_ANGELES )(1, 1st Order)  top
  • GUIDANCE(4, 0 Order)
  • ( GUIDANCE )(4, 0 Order)  top
  • References

    • ( HOSPITALS )  top
    • ( HOSPITALS, HEALTH )  top
    • (Read more)   top
      Truog said he worked all weekend helping hospitals develop policies that determine who receives intensive care during a public health emergency.
    • (Read more)   top
      "Everyone who is normally eligible for intensive care remains eligible in a public health emergency," White said.
      Several hundred hospitals around the country have adopted White's framework, he said
    • (Read more)   top We are working to update our guidelines," a Department of Health spokesperson wrote.
      At Harvard, Truog, who supports White's framework, has recently published articles in the New England Journal of Medicine and the Boston Globe to help prepare hospitals, doctors...
    • ( HOSPITALS, DOCTORS )  top
    • (Read more)   top
      In the event of a tie, White's framework directs doctors to consider life cycle, with priority being given to younger patients.
      "These are inevitably tragic choices with only bad options," White said
    • (Read more)   top
      At Harvard, Truog, who supports White's framework, has recently published articles in the New England Journal of Medicine and the Boston Globe to help prepare hospitals, doctors and the public for the decisions and outcomes he thinks they could be facing soon.
      That kind of forethought by specialists is important, White has argued, so that doctors facing a pandemic don't...
    • ( HOSPITALS, POLICIES )  top
    • (Read more)   top
      Truog said he worked all weekend helping hospitals develop policies that determine who receives intensive care during a public health emergency.
    • ( HOSPITALS, NEW_ENGLAND_JOURNAL )  top
    • (Read more)   top
      At Harvard, Truog, who supports White's framework, has recently published articles in the New England Journal of Medicine and the Boston Globe to help prepare hospitals, doctors and the public for the decisions and outcomes he thinks they could be facing soon.
      That kind of forethought by specialists is important,...
    • ( HOSPITALS, MEDSTAR )  top
    • (Read more)   top. The first set of hospitals, including Johns Hopkins and Medstar, came on board after a 2009 article on the system, White said.
      But since early March this year, his email has been flooded by hospitals'requests for guidance
    • ( HOSPITALS, JOHNS_HOPKINS )  top
    • (Read more)   top. The first set of hospitals, including Johns Hopkins and Medstar, came on board after a 2009 article on the system, White said.
      But since early March this year, his email has been flooded by hospitals'requests for guidance
    • ( HOSPITALS, ICU )  top
    • (Read more)   topTypically, adult patients will stay in the ICU -- and on a ventilator -- for only three to four days, as one Connecticut doctor explained, but Covid-19 patients need them for up to two or three weeks, dramatically increasing demand.
      Truog said...
    • ( HOSPITALS, HARVARD )  top
    • (Read more)   top
      At Harvard, Truog, who supports White's framework, has recently published articles in the New England Journal of Medicine and the Boston Globe to help prepare hospitals, doctors and the public for the decisions and...
    • ( HOSPITALS, FORETHOUGHT )  top
    • (Read more)   top
      That kind of forethought by specialists is important, White has argued, so that doctors facing a pandemic don't have to struggle with such dire ethical questions case by case
    • ( HOSPITALS, COVID-19 )  top
    • (Read more)   top (CNN)With the peak of Covid-19 infections still ahead and medical supplies still scarce, hospitals and physicians are gearing up for a nearly impossible challenge: deciding who gets a life-saving ventilator and who doesn't.
      "Physicians...
    • (Read more)   topTypically, adult patients will stay in the ICU -- and on a ventilator -- for only three to four days, as one Connecticut doctor explained, but Covid-19 patients need them for up to two or three weeks, dramatically increasing demand.
      Truog said he worked all weekend helping hospitals develop policies that determine who receives intensive care during...
    • ( HOSPITALS, BOSTON_GLOBE )  top
    • (Read more)   top
      At Harvard, Truog, who supports White's framework, has recently published articles in the New England Journal of Medicine and the Boston Globe to help prepare hospitals, doctors and the public for the decisions and outcomes he thinks they could be facing soon.
      That kind of forethought by specialists is important, White has argued, so that...
    • ( HEALTH )  top
    • ( HEALTH, DOCTORS )  top
    • (Read more)   top
      "So their crisis standard of care guidance now basically provides no guidance to doctors about what to do in the face of ventilator shortages, which of course introduces its own thicket of problems around variability and bias," White wrote in an email.
      Two other states, Tennessee...
    • (Read more)   topSee ( HOSPITALS , DOCTORS )
    • (Read more)   top White believes that triage committees should be created of non-frontline doctors, to "enhance objectivity, avoid conflicts of commitments, and minimize moral distress."
      Dr. Ira Byock, a palliative care physician in Los Angeles and founder of the Institute for Human Caring...
    • ( HEALTH, GUIDANCE )  top
    • (Read more)   topUPMC confirmed that its 40 hospitals have since adopted the framework, and White said the state of Pennsylvania has implemented interim guidance to public hospitals based on his framework as well. Pennsylvania's Department of Health would not give details on the basis for their interim guidelines but said they intend to publish final guidelines...
    • (Read more)   top Like Alabama's, it lacks guidance on how to triage patients for access to ventilators.
      That is hardly a solution, White said after reviewing the new Alabama guidelines.
      "So their crisis standard of care guidance now basically...
    • (Read more)   top
      But even with the ethical guidance that a framework like White's provides, Truog said, that responsibility means the road ahead for American doctors will not be easy.
      "It could very well be the case that in the next few days...
    • ( HEALTH, WELL-BEING )  top
    • (Read more)   top
      "For the first time in our experience, we have to balance the well-being of the community with the well-being of individual patients, which is usually our sole focus," Byock said.
      But even with the ethical guidance that a framework like White's provides, Truog...
    • ( HEALTH, UNIVERSITY )  top
    • (Read more)   top One of the better frameworks to follow, he said, is one developed by Dr. Douglas White, a professor of critical care medicine at the University of Pittsburgh and the University of Pittsburgh Medical Center (UMPC).
      White said he began to develop his framework more than a decade ago during the avian influenza epidemic.
      It is essentially...
    • ( HEALTH, TRUOG )  top
    • (Read more)   top
      But even with the ethical guidance that a framework like White's provides, Truog said, that responsibility means the road ahead for American doctors will not be easy.
      "It could very well be the case that in the next few days physicians are going to have to make decisions that...
    • ( HEALTH, TRIAGE )  top
    • (Read more)   top Like Alabama's, it lacks guidance on how to triage patients for access to ventilators.
      That is hardly a solution, White said after reviewing the new Alabama guidelines.
      "So their crisis standard of care guidance now basically provides no guidance...
    • (Read more)   top White believes that triage committees should be created of non-frontline doctors, to "enhance objectivity, avoid conflicts of commitments, and minimize moral distress."
      Dr. Ira Byock, a palliative care physician...
    • ( HEALTH, PENNSYLVANIA )  top
    • (Read more)   topUPMC confirmed that its 40 hospitals have since adopted the framework, and White said the state of Pennsylvania has implemented interim guidance to public hospitals based on his framework as well. Pennsylvania's Department of Health would not give details on the basis for their interim guidelines but said...
    • ( HEALTH, ICU )  top
    • (Read more)   topSee ( HOSPITALS , ICU )
    • (Read more)   top
      It is essentially a point system calculating a patient's likelihood to benefit from ICU care, based on two considerations: 1) saving the most lives and 2) saving the most life-years.
      The lower the patient scores, the higher their prioritization for care
    • ( HEALTH, PROVIDENCE_TRINITYCARE_HOSPICE )  top
    • (Read more)   top
      Dr. Ira Byock, a palliative care physician in Los Angeles and founder of the Institute for Human Caring based at Providence TrinityCare Hospice in California, said that the usual clinical ethics for doctors change during a public health crisis.
      "For the first time in our experience, we have to balance the well-being of the community with...
    • ( HEALTH, POLICIES )  top
    • (Read more)   top
      Truog said he worked all weekend helping hospitals develop policies that determine who receives intensive care during a public health emergency. One of the better frameworks to follow, he said, is one developed by Dr. Douglas White, a professor of critical care medicine...
    • ( HEALTH, PITTSBURGH_MEDICAL_CENTER )  top
    • (Read more)   top One of the better frameworks to follow, he said, is one developed by Dr. Douglas White, a professor of critical care medicine at the University of Pittsburgh and the University of Pittsburgh Medical Center (UMPC).
      White said he began to develop his framework more than a decade ago during the avian influenza epidemic.
      It is essentially a point system calculating a patient's likelihood to benefit...
    • ( DOCTORS )  top
    • ( DOCTORS, TRUOG )  top
    • (Read more)   top
      Robert Truog, director of the Center for Bioethics at Harvard Medical School, says American doctors may face new ethical challenges in trying to triage limited ventilators for Covid-19 patients.
      The demand for...
    • (Read more)   topSee ( HEALTH , TRUOG )
    • ( DOCTORS, WELL-BEING )  top
    • (Read more)   topSee ( HEALTH , WELL-BEING )
    • ( DOCTORS, TRIAGE )  top
    • (Read more)   top
      Robert Truog, director of the Center for Bioethics at Harvard Medical School, says American doctors may face new ethical challenges in trying to triage limited ventilators for Covid-19 patients.
      The demand for ventilators has skyrocketed in intensive care units across the country as coronavirus patients have flooded in
    • (Read more)   topSee ( HEALTH , TRIAGE )
    • ( DOCTORS, AMERICAN )  top
    • (Read more)   top
      Robert Truog, director of the Center for Bioethics at Harvard Medical School, says American doctors may face new ethical challenges in trying to triage limited ventilators for Covid-19 patients.
      The demand for ventilators has skyrocketed in intensive care units across the country as coronavirus...
    • (Read more)   top
      But even with the ethical guidance that a framework like White's provides, Truog said, that responsibility means the road ahead for American doctors will not be easy.
      "It could very well be the case that in the next few days physicians are going to have to make decisions that they never even contemplated before, and the emotional toll...
    • ( DOCTORS, VENTILATORS )  top
    • (Read more)   top
      Robert Truog, director of the Center for Bioethics at Harvard Medical School, says American doctors may face new ethical challenges in trying to triage limited ventilators for Covid-19 patients.
      The demand for ventilators has skyrocketed in intensive care units across the country as coronavirus patients have flooded in
    • (Read more)   top Like Alabama's, it lacks guidance on how to triage patients for access to ventilators.
      That
      is hardly a solution, White said after reviewing the new Alabama guidelines.
      "So their crisis standard of care guidance now basically provides no guidance to doctors about what to do in the face...
    • ( DOCTORS, PROVIDENCE_TRINITYCARE_HOSPICE )  top
    • (Read more)   topSee ( HEALTH , PROVIDENCE_TRINITYCARE_HOSPICE )
    • ( DOCTORS, PALLIATIVE )  top
    • (Read more)   top
      Dr. Ira Byock, a palliative care physician in Los Angeles and founder of the Institute for Human Caring based at Providence TrinityCare Hospice in California, said that the usual clinical ethics for doctors change during a public...
    • ( DOCTORS, OBJECTIVITY )  top
    • (Read more)   top White believes that triage committees should be created of non-frontline doctors, to "enhance objectivity, avoid conflicts of commitments, and minimize moral distress."
      Dr. Ira Byock, a palliative care physician in Los Angeles and founder of the Institute for Human Caring based at Providence TrinityCare Hospice...
    • ( DOCTORS, NON-FRONTLINE )  top
    • (Read more)   top White believes that triage committees should be created of non-frontline doctors, to "enhance objectivity, avoid conflicts of commitments, and minimize moral distress."
      Dr. Ira Byock, a palliative care physician in Los Angeles and founder of the Institute for...
    • ( DOCTORS, NEW_ENGLAND_JOURNAL )  top
    • (Read more)   topSee ( HOSPITALS , NEW_ENGLAND_JOURNAL )
    • ( DOCTORS, LOS_ANGELES )  top
    • (Read more)   top
      Dr. Ira Byock, a palliative care physician in Los Angeles and founder of the Institute for Human Caring based at Providence TrinityCare Hospice in California, said that the usual clinical ethics for doctors change during a public health crisis.
      "For...
    • ( GUIDANCE )  top
    • (Read more)   top... hospitals, including Johns Hopkins and Medstar, came on board after a 2009 article on the system, White said. But since early March this year, his email has been flooded by hospitals'requests for guidance. UPMC confirmed that its 40 hospitals have since adopted the framework, and White said the state of Pennsylvania has implemented interim guidance to public hospitals based on his framework as well
    • (Read more)   top ... or profound mental retardation" and "moderate to severe dementia" are "unlikely candidates for ventilator support." Those guidelines were updated in February 2020, but the new guidance makes no mention of how to triage patients in the event of ventilator shortages. The Alabama Department of Public Health did not confirm whether exclusion criteria are still being used. In a 2014...
    • (Read more)   top The state told a CNN reporter that these are "not part of our current response plan" and sent a link to a new plan. Like Alabama's, it lacks guidance on how to triage patients for access to ventilators. That is hardly a solution, White said after reviewing the new Alabama guidelines. "So their crisis standard of care guidance now basically...
    • (Read more)   top ... first time in our experience, we have to balance the well-being of the community with the well-being of individual patients, which is usually our sole focus," Byock said. But even with the ethical guidance that a framework like White's provides, Truog said, that responsibility means the road ahead for American doctors will not be easy. "It could very well be the case that in the next few days...