The California Department of Public Health has now decided that if a “worst-case scenario” arises from the coronavirus, younger people and health care workers “vital to the acute care response” would be prioritized over others.

The 38-page document by the California Department of Public Health starts with a letter from Dr. Sonia Angell, director of the California Department of Public Health, in which she states of the guidelines:

Anchored in best practices from across the country, and guided by ethical principles and a commitment to equity, it provides a framework to help health care facilities and county health departments plan for the potential of a COVID-19 surge that is overwhelming. It aims to ensure that, should conditions push our systems into providing crisis care, we do so in a coordinated and thoughtful manner, using a common framework, procedures, and decision making that best protects the health of all Californians.

The guidelines state: “The ethical justification for incorporating the life-cycle principle is that it is a valuable goal to give individuals equal opportunity to pass through the stages of life — childhood, young adulthood, middle age, and old age. The justification for this principle does not rely on considerations of one’s intrinsic worth or social utility. Rather, younger individuals receive priority because they have had the least opportunity to live through life’s stages.”

The document adds, “We suggest that life-cycle considerations should be used as a tiebreaker if there are not enough resources to provide to all patients within a priority group, with priority going to younger patients. We recommend the following categories: age 12-40, age 41-60; age 61-75; older than age 75. The ethical justification for incorporating the life-cycle principle is that it is a valuable goal to give individuals equal opportunity to pass through the stages of life— childhood, young adulthood, middle age, and old age.

The Los Angeles Times reported, “The scoring system would assess potential organ failure risk and the presence of life-limiting conditions to determine prognoses for hospital survival and longer-term survival. For example, major life-limiting chronic diseases, such as moderate Alzheimer’s disease or moderately severe chronic lung disease, would add two points to someone’s score. Chronic diseases likely to cause death within a year’s time, such as severe Alzheimer’s disease or severe chronic lung disease, could add four points.”

The Times added, “Total scores would range from one to eight, with priority for ventilators given to those with lower scores. If there are not enough resources to treat all patients with the same score, the guidelines suggest hospitals group patients by age — ages 12-40, 41-60, 61-75 and older than 75 — and treat younger people first.”

The document states, “Individuals who perform tasks that are vital to the public health response, including all those whose work directly supports the provision of acute care to others, should be given heightened priority.”

Democratic state Sen. Richard Pan, a medical doctor, told the Times that creating a blueprint for a crisis that may come was vital, asserting, “That’s where the rubber meets the road. You can put [guidelines] out and have people discuss them, or if you don’t have them when the crisis comes, each person at the bedside is figuring it out for themselves. At least we have standards and an opportunity to discuss it. If everyone stays home and we continue to flatten the curve, then hopefully we won’t get to the point where we have to make these decisions.”

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