More than a year into the COVID-19 pandemic that’s claimed the lives of more than 1,000 Manitobans, the Manitoba government and health-care officials still have not developed triage protocols for doctors.
Triage protocols lay out guidelines for doctors and health-care providers who may need to make dire decisions when it comes to who gets treatment over another.
“You would look at a lot of things, including their pre-morbid status and what you think would be their chance of survival and essentially you kind of compare patients,” Ontario critical care physician Dr. Alex Patel said.
It’s not a common practice in Canada and other developed countries to need such protocols, said Patel, but COVID-19 and how it has overwhelmed the health-care system means it’s needed.
“When you have a limited resource, you end up giving it to those that you think have the best chance of survival and patients that otherwise would have gotten life support in an ICU or kind of denied that because of the limitations,” he said.
He added that decisions are not taken lightly and would be done in consultation with a number of doctors but ultimately it comes down to who would have the better chance of survival.
“It weighs on you mentally. It’s difficult. As we got closer and closer … that creates a lot of stress, a lot of emotional anxiety,” he said.
“I mean, nobody wants to play God, and that’s not why we’re here.”
Last April, the Manitoba government said it was working on putting together a triage protocol. By the time Manitoba’s second wave hit in the fall, doctors feared it was going to be needed as intensive care units filled up and the health-care system was reaching a tipping point.
But in the midst of Manitoba’s third wave, which many doctors worry could be worse than the previous ones, there is still no triage document.
“I have not seen one in Manitoba,” chief nursing officer Lanette Siragusa said during a Monday press conference. “To my knowledge, we have not (made one) and I would be involved if that was coming to fruition.”
Siragusa said they hope it never gets to a point where those decisions need to be made.
But that’s not good enough for others.
“They should already exist. It is puzzling…. This is 15 months that we’ve been in this pandemic and we’ve known that this could happen at any time,” ethicist Neil McArthur said.
“Unfortunately, I think the government has just perhaps been really reluctant to have this conversation in an open way or they don’t want to admit that it could happen.”
McArthur, director of the Centre for Professional and Applied Ethics at the University of Manitoba, said groups that work with seniors and Manitobans with disabilities should play a significant consultation role in the plan and that it should be made public.
“The general principle that most medical ethicists will use is trying to save the most life years, meaning, you know, trying to prioritize people who have the best chance of survival and people who will survive the longest following this treatment,” McArthur said.
But there also needs to be consideration given for accommodations, he added.
“There are many people who, for reasons of age or disability, just don’t have the same chance for an outcome. So I think that there’s no magic bullet for that,” he said.
These are the types of conversations McArthur said the government and health officials should have been having months ago while putting together a plan. But he worries the time for a plan may already have passed.
“It may be too late for this. There was an obligation. Unfortunately, we can’t go back in time.”