Weighing the ethical aspects of the COVID-19 crisis

Other Side of 50


I very much appreciate the ethical framework and rigor the extended healthcare system is using to determine how to allocate limited resources during the pandemic

I very much appreciate the ethical framework and rigor the extended healthcare system is using to determine how to allocate limited resources during the pandemic

There’s no debating that seniors are most at risk during this pandemic. While COVID-19 deaths have spanned all age groups, the hardest hit has been the 65-and-older population, which accounts for over 80% of the U.S. death toll from the disease.

A friend offered her opinion that this pandemic may just be nature’s way of getting rid of the weak, that seniors had lived a full life and this was just their time to go. In other words, she felt that older adults are collateral damage in this global health crisis.

I found this to be shocking. She immediately walked back her words, remembering who she was talking to, but it does show that this opinion is out there.

Let’s look at what these same older adults may have endured in the course of their lives.

Many adults who have lived to an older age have survived a range of challenges: cancers, strokes, heart attacks, accidents, military combat, poverty, abuse, childhood disease and loss of loved ones. Their lives often came with hardship and misfortune, but they survived.

Andrea Gallagher, a certified senior advisor, is president of Senior Concerns, a nonprofit agency serving Ventura and western Los Angeles counties. For more information, visit seniorconcerns.org, and for comments or questions, email agallagher@seniorconcerns.org.

Andrea Gallagher, a certified senior advisor, is president of Senior Concerns, a nonprofit agency serving Ventura and western Los Angeles counties. For more information, visit seniorconcerns.org, and for comments or questions, email agallagher@seniorconcerns.org.

Many are old because they were strong and overcame challenges.

These same individuals have helped to build our cities, serve in our military and in government, teach in schools, build our industries and tend to our sick.

More importantly, these older adults are our parents, siblings, neighbors, co-workers and friends.

Why wouldn’t we want or expect them to be cared for and protected during a major health crisis? And how are decisions pertaining to older adults being made during the pandemic?

With regard to the distribution of the vaccine, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices released its recommendation that the highest priority group include frontline healthcare workers and long-term care residents, who are often older adults.

The committee then recommended that other essential workers be the next priority group, followed by people 65 and older and those with conditions that place them at high risk for severe illness from COVID-19.

States look to and often follow the committee’s guidance, but the federal recommendations are not binding, and some states may choose to depart from the suggestions.

With regard to intensive care unit beds in hospitals, if physicians must choose who gets a bed because the ICUs are full, it raises major ethical dilemmas related to which patients should benefit from the limited resources and which should not.

The stay-home order has been enacted to reduce the spread of the disease and therefore the number of patients who will need an ICU bed, especially now that ICUs have zero percent capacity.

In principle, ICUs are reserved for patients who physicians believe can be expected to recover with a good quality of life. Admitting patients who are going to die, regardless of any medical effort, is not protocol. Similarly, patients who are not severely ill and do not really require intensive care should not be admitted.

Hospitals use “distributive justice” to determine who receives ICU beds. The general principles of distributive justice include considering the patient’s age and life expectancy, comorbidities, advanced underlying illnesses, expected quality of life and resources associated with achieving the benefit to the patient.

The age of the patient is important, but it is not the only element that is considered. An older patient who is independent and active, with no previous medical conditions, may take precedence over a younger individual with advanced cancer, severe heart failure or alcoholic cirrhosis.

Additionally, the patient’s own preferences (hopefully noted in their advance directive) should be considered and discussed early in the disease process whenever possible.

I’m sure we will have a lot to consider when we come out on the other side of this health crisis, but as a devoted advocate for seniors, I very much appreciate the ethical framework and rigor the extended healthcare system is using to determine how to allocate limited resources during the pandemic.