In a Nightmare Scenario, How Should We Decide Who Gets Care?

In northern Italy, doctors were forced to begin rationing ventilators and other equipment—a nightmare scenario that could become a reality for medical staff in the United States soon; New York has projected ventilator shortages in the thousands per week. David Remnick talks with Philip Rosoff, a professor of Medicine at Duke University and a scholar of bioethics who has studied rationing. Rosoff believes medical institutions must also consider the needs of those who can’t be saved, and suggests that hospitals should stock up on drugs to ease suffering at the end of life. Rosoff notes that the U.S. medical system puts an emphasis on “go for broke” care at all costs, and is poorly prepared for those kinds of decisions, which leave hospital workers with an acute sense of “moral distress.” “If we’re smart, we would have institutional guidelines and plans in place ahead of time,” Rosoff says. “The way not to make [a rationing decision] is to make it arbitrarily, capriciously, unilaterally, and at the bedside in the moment.”