The hospital I’m at has been on divert status multiple times this month ( this is not uncommon ). That basically means that the ED is full, and can’t accept any more patients. For us, it’s also worked out to mean that our entire hospital is full, including the ICU. There are no open spots. Anywhere.

This prevents surgeries from happening (because there’s no place to put the patients for monitoring after the surgery), and it prevents truly sick people that walk into the ED from getting hospitalized, too. Our schedulers and case workers and discharge planners knock on our doors daily, desperately seeking patients who might be going home. And with our aging population , I really can’t see this getting any better. Nursing shortages make this worse, because of staffing, especially on the weekend, open beds can’t always be turned into patient beds, because of nurse to patient ratios.

This obviously brings up something of an ethical dilemma, where the lofty goals and aspirations of perfect medicine hit the limited resources pavement. There are several people in the ICU who have been there for as much as 8 months or even a year–in comas, on respirators–with little hope of improvement. Yet their living wills insist that they remain on a ventilator, or their family members insist–even despite the patient’s own declared wishes. And so they remain. Then there are others who come back time after time with the same serious problem, sometimes self-induced.

I could easily argue this point either way, and where you stand probably boils down to where you sit on issues of individual or group mentality. Should we do what’s best for any one individual, at the possible cost to the group, or should we sacrifice an individual for the good of the group? (I myself am a total hypocrite, preferring the group mentality in theory, but the individual mentality when it comes to my own health.)

I guess I mainly worry that this problem won’t just go away, and that whatever solution we come to will be one decided either at the last minute, or will be decided based on the most unethical of deciding factors: money. There’s of course an alternative I haven’t discussed here: just build more hospitals, more nursing homes, more clinics, and try to squeeze everyone in, but that will probably just lead to worse nursing and doctor shortages, and lead us deeper into the red.

Any of my answers turn my stomach, so I guess it’s up to choosing between the lesser of two evils.

1. First-come first-serve doesn’t really seem appropriate; just because you got sick when there was an available hospital bed shouldn’t decide whether you get care.
2. There’s a “he who contributes most deserves most” idea, but it’s rotten, too–just because subjectively one person “contributes” more to society than another shouldn’t necessarily buy them more or better care than someone else.
3. You can also go by age alone–that children should get more extensive and intensive care than the elderly, because in someone’s words, “children haven’t been able to live their lives yet,” but some elderly folks may still have better prognoses than some very sick children.
4. There’s a functional cutoff–if you’re “high-functioning” and you get sick, you should get extensive treatment, but if you’re low-functioning (again, the definition is a problem), you’re out of luck.
5. Or how about an formula based on your chances of recovery, partial recovery, or no recovery, based on all the data we have available?

I don’t particuarly like any of these for many reasons. You can’t arbitrarily sign a death sentence for a person, and you can’t take away a person’s hope so quickly. I don’t know what’s going to happen, but it really, really frightens me.

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