Australian Reports of the Virus Spread

[Lynda2475]

the majority of people who die of covid have at least 4 co morbidities

Exactly.

MyMum who is elderly, has cancer and is severely underweight sailed through covid, she found taking the anti-virals more difficult than the sniffles that Covid bought. So elderly people even those with comorbidities can come through unscathed.

 

[Lynda2475]

...and what if the opinion of that individual is warped due to mental health issues? What you are saying sounds good on the surface but is appalling in the reality of the real world.

Not at all, there are successful euthanasia schemes running in Europe that we should have here. Playing the mental health card is a total cop out, a arrogant loophole to try and over rule a persons wishes. If you are terminal and wish to be given a little extra morphine to exit this world pain free your choice should be honoured, being forced to suffer through zero quality of life for someone else is quite simply abuse.

I have my ducks lined up legally, very clear instructions regarding care and any end of life decisions, good luck to any do gooder who tries to claim I was mentally ill when my lawyer captured my wishes, they will be hauled into court.

 

[Lynda2475]

As it turns out, that may likely have been the wrong decision. As some point out on these threads, very few young people have died from covid, so they probably didn’t need the priority that would have been afforded them.

That is illogical, a young person who was not critically ill and not in genuine need of a ICU bed would never have been given priority for an ICU bed over an elderly person.

However in the instance where there is 1 ICU bed and two critically ill patients needing it, it totally makes sense to prioritise the younger person if they have the best chance of recovery.

 

[MEL_Traveller]

That is illogical, a young person who was not critically ill and not in genuine need of a ICU bed would never have been given priority for an ICU bed over an elderly person.

However in the instance where there is 1 ICU bed and two critically ill patients needing it, it totally makes sense to prioritise the younger person if they have the best chance of recovery.

Why? If the young person was going to recover anyway as the statistics suggest, why not have the chance for two people come out alive instead of just one who was going to survive anyway?

 

[Lynda2475]

Why? If the young person was going to recover anyway, as the statistics suggest, why not have the chance for two people come out alive instead of just one who was going to survive anyway?

Because someone who needs ICU intervention even if they are young is unlikely to come out alive anyway without that ICU intervention.

You are comparing apples and oranges.

Its true a young healthy person who gets covid, will almost always come through unscathed without need for hospitalisation or any medical treatment at all. But those individuals aren't preventing an older person who is seriously ill from accessing an ICU bed or other treatment.

Very different from the rare case where a younger person gets seriously ill with covid and actually needs medical intervention in ICU (due to their other underlying conditions). In that case, if there are ICU bed shortages and a doctor is choosing who gets the ICU bed the seriously ill younger person or the seriously ill geriatric person, all other things being equal it would generally be prudent to prioritise the younger. Tough choices get made all the time.

 

[straitman]

Not at all, there are successful euthanasia schemes running in Europe that we should have here. Playing the mental health card is a total cop out, a arrogant loophole to try and over rule a persons wishes. If you are terminal and wish to be given a little extra morphine to exit this world pain free your choice should be honoured, being forced to suffer through zero quality of life for someone else is quite simply abuse.

I have my ducks lined up legally, very clear instructions regarding care and any end of life decisions, good luck to any do gooder who tries to claim I was mentally ill when my lawyer captured my wishes, they will be hauled into court.

I agree with your first sentence but totally disagree with the second. I regularly see people who would now be dead if their wishes had been followed but are now VERY happy that there was intervention and they are now still alive. I do also agree with you that the MH card is very often overplayed however there are many occasions when it's used appropriately and with good results. Simply dismissing it is (IMHO) worse than overusing it.

 

[Port Power]

Very different from the rare case where a younger person gets seriously ill with covid and actually needs medical intervention in ICU (due to their other underlying conditions). In that case, if there are ICU bed shortages and a doctor is choosing who gets the ICU bed the seriously ill younger person or the seriously ill geriatric person, all other things being equal it would generally be prudent to prioritise the younger. Tough choices get made all the time.

You finally actually came to the point that @drron was making! Difficult decisions that the doctor has to live with.

 

[MEL_Traveller]

You finally actually came to the point that @drron was making! Difficult decisions that the doctor has to live with.

And my issue is that ‘a’ doctor should not have the power to make that decision. It should only be made after consultation - an independent panel perhaps, comprised of both medical and non-medical representatives - and with clear avenues of appeal for the disadvantaged party.

This also removed the burden from a single doctor having to consider their decisions post fact.

 

[OZDUCK]

The WA Dept of Health have been handing out RAT tests at my small local shopping centre all this week. Everyone gets ten at a time - I felt like I was at a kids party getting my lolly bag. From my unskilled observations mask wearing there is at about 40% but I mainly shop during working hours with all the other oldies. There was always some mask wearing anyway due to my area having a relatively large ethnic Chinese population.

 

[andye]

And my issue is that ‘a’ doctor should not have the power to make that decision. It should only be made after consultation - an independent panel perhaps, comprised of both medical and non-medical representatives - and with clear avenues of appeal for the disadvantaged party.

This also removed the burden from a single doctor having to consider their decisions post fact.

Decisions like this are very common and to some extent what doctors are paid to do (I.e efficiently make multiple life-changing decisions within an ethical framework and in consultations with patients/person responsible). There are celebrated cases that end up in the domain of lawyers and ethicists. However most times decisions need to be made in the moment and the speed of ethicists and lawyers is comparatively glacial. The system would grind to a halt with the sort of independent panel I assume you are envisaging (not to mention could prove an effective way of making healthcare even more expensive)

 

[Port Power]

And my issue is that ‘a’ doctor should not have the power to make that decision. It should only be made after consultation - an independent panel perhaps, comprised of both medical and non-medical representatives - and with clear avenues of appeal for the disadvantaged party.

This also removed the burden from a single doctor having to consider their decisions post fact.

Not for an ICU bed. It would take too long to convene a panel to make such a decision, and meanwhile the bed remains empty for days with dire consequences for all patients. Conferring with colleagues is appropriate.

Edit: @andye gave a more eloquent reply while I was typing mine. As stated, these are some of the decisions emergency and other doctors train for.

 

[Lynda2475]

Simply dismissing it is (IMHO) worse than overusing it.

Not for the person suffering because they are being forced to live in extreme physical pain against their will, because someone else doesn't agree with their life choices. So we can agree to disagree.

You finally actually came to the point that @drron was making! Difficult decisions that the doctor has to live with.

I was already there, you were the one making a crazy case equating outcomes for healthy young people with those needing ICU care. I've never had a problem with difficult decisions, I go by the evidence which is that if that difficult decision has to be made the younger person is the right one.

For all the alarm some on this thread are still raising, most are living with covid just fine.

 

[MEL_Traveller]

Decisions like this are very common and to some extent what doctors are paid to do (I.e efficiently make multiple life-changing decisions within an ethical framework and in consultations with patients/person responsible). There are celebrated cases that end up in the domain of lawyers and ethicists. However most times decisions need to be made in the moment and the speed of ethicists and lawyers is comparatively glacial. The system would grind to a halt with the sort of independent panel I assume you are envisaging (not to mention could prove an effective way of making healthcare even more expensive)

Obviously speed is if the essence. I don’t see it as dissimilar to a Bail Justice, who can be called at short notice.

Perhaps it’s something smaller, a single non-doctor who can weight up the subjective with the objective.

This is only to combat the notion a single doctor is making life and death decisions, as claimed. If there’s actually an existing framework and process, and the rights of the disadvantaged are protected, no need to change the status quo.

Of course if this really became an ongoing issue, a panel would be established and waiting.

 

[drron]

Just to set the record straight. it is usually not a single doctor making a decision. I would always talk to the patient about what they wanted and if they don't agree or unsure we always convene a family meeting with the team which includes the junior doctors,nurses and allied health. The family are present as well.

And in the case of ICU beds there often is disagreement with the family often wanting everything possible done when it is clearly inappropriate. Then I hope there is a really good director of Intensive care to be present. Fortunately in both Launceston and Townsville the ICU directors were excellent. Probably because they are women.

 

[jeza]

The WA Dept of Health have been handing out RAT tests at my small local shopping centre all this week. Everyone gets ten at a time - I felt like I was at a kids party getting my lolly bag. From my unskilled observations mask wearing there is at about 40% but I mainly shop during working hours with all the other oldies. There was always some mask wearing anyway due to my area having a relatively large ethnic Chinese population.

The person at the shopping centre I visited today was handing out 20 at a time. Must have wanted to knock off early on a Friday!

 

[RooFlyer]

Found out a neighbour of mine had covid a week ago. Lady in her 80s, who in general was not very well (overweight and with a number of 'co-morbidities'). Was 'crook' for a day, according to husband; GP prescribed antivirals, delivered that afternoon. Got well again quickly and clear of symptoms 4 days later.

 

[OZDUCK]

The person at the shopping centre I visited today was handing out 20 at a time. Must have wanted to knock off early on a Friday!

There were two of them handing them out and they were barely keeping up with the demand. I think they might be there for short periods every day. Our daughter actually used one of new supply here this afternoon as she has got a bad cough. Happily a negative result and it seems just to be an old fashioned cold and not a re-infection.

 

[Princess Fiona]

Decisions like this are very common and to some extent what doctors are paid to do (I.e efficiently make multiple life-changing decisions within an ethical framework and in consultations with patients/person responsible). There are celebrated cases that end up in the domain of lawyers and ethicists. However most times decisions need to be made in the moment and the speed of ethicists and lawyers is comparatively glacial. The system would grind to a halt with the sort of independent panel I assume you are envisaging (not to mention could prove an effective way of making healthcare even more expensive)

Not to mention that what happens way more often in the case of two patients needing the same ICU bed is that a third patient who would have been an elective admission post op has their surgery cancelled and both critical patients get beds.

 

[Quickstatus]

Bail Justice

On call 24hrs a day, 365 days a year?

single non-doctor

who?. what qualifications would the non doctor require to bring to bear re decisions on who gets the ICU bed or not?

a panel

of whom?
Would it work like a tribunal? What tribunal is awake and ready for proceedings at 1am?

**For the above lets use a simple example and I mean this is a simple example because this scenario is commonly played out**
Its 1am on a Saturday morning

2x 90 year old patients. Similar medical history. One comes into hospital emergency department in cardiac arrest but is resuscitated, but now on a ventilator. Needs an ICU bed. The other one came in earlier broke the hip, is in surgery but they ring to say his heart stopped but has now been restarted. Needs ICU . Also on a ventilator. Both need ICU beds. Unable to transfer to another hospital as they both have Covid and ICUs full. It winter, beds full. You only have one ICU bed. Who gets the bed. Are you really going to ring up a bail justice, a non doctor and some panel to adjudicate?. You want the doctors to appear before these people, when they may have other patients in the queue.

Im sorry this is not thought out properly.

 

[Quickstatus]

third patient

or a third patient currently in ICU gets shunted to the wards to make room.
or a patient in ED needing ICU stays in ED until bed available -which may be another day or transferred

No one who needs emergency treatment is denied treatment.