There’s no debating that seniors are most at risk during this pandemic. While COVID-19 deaths have spanned all age groups, the hardest hit has been the 65-and-older population, which accounts for over 80% of the U.S. death toll from the disease.
A friend offered her opinion that this pandemic may just be nature’s way of getting rid of the weak, that seniors had lived a full life and this was their time to go. In other words, she felt that older adults are collateral damage in this global health crisis.
I found this to be shocking. She immediately walked back her words, but it does show that this opinion is out there.
Let’s look at what these older adults may have endured in the course of their lives.
Many people who have lived to an older age have survived a range of challenges: cancers, strokes, heart attacks, accidents, military combat, poverty, abuse, childhood disease and loss of loved ones.
Many are old because they were strong and overcame challenges.
These same individuals have built our cities and industries, served in our military and in government, taught in schools and tended to our sick.
More importantly, these older adults are our parents, siblings, neighbors, co-workers and friends.
Why wouldn’t we want or expect them to be cared for and protected during a major health crisis? How are decisions pertaining to older adults being made?
With regard to the distribution of the vaccine, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices released its recommendation that the highest priority group include frontline healthcare workers and long-term care residents, who are often older adults.
The committee then recommended that other essential workers be the next priority group, followed by people 65 and older and those with conditions that place them at high risk for severe illness from COVID-19.
With regard to intensive care unit beds in hospitals, if physicians must choose who gets a bed because the ICUs are full, it raises major ethical dilemmas related to which patients should benefit from the limited resources.
The stay-home order has been enacted to reduce the spread of the disease and therefore the number of patients who will need an ICU bed, especially now that ICUs have 0% capacity.
In principle, ICUs are reserved for patients who physicians believe can be expected to recover with a good quality of life. Admitting patients who are going to die, regardless of any medical effort, is not protocol. Similarly, patients who are not severely ill and do not require intensive care should not be admitted.
Hospitals use “distributive justice” to determine who receives ICU beds. The general principles include considering the patient’s age and life expectancy, comorbidities, advanced underlying illnesses and expected quality of life.
The age of the patient is important, but it is not the only element that is considered. An older patient who is independent and active, with no previous medical conditions, may take precedence over a younger individual with a serious illness.
Additionally, the patient’s own preferences (hopefully noted in their advance directive) should be considered and discussed whenever possible.
I’m sure we will have a lot to consider when we come out on the other side of this health crisis, but as a devoted advocate for seniors, I very much appreciate the ethical framework and rigor the extended healthcare system is using to determine how to allocate limited resources during the pandemic.