This article reports on the potential that ventilators may be reallocated from long-term care facilities to hospitals to respond to resource scarcity due to COVID-19 case surge, including the controversial possibility of disconnecting ventilators currently in use by long-term ventilator-dependent patients.
The article reports that nursing homes in the US have approximately 8,200 ventilators, often used by patients who have suffered brain injury or stroke. While some nursing homes have reported lending ventilators not currently in use to nearby hospitals to increase available supply for COVID-19 response, the possibility of withdrawing ventilator support from chronic care patients who are dependent on them is much more ethically challenging.
The goal of resource allocation in most guidelines for crisis standards of care is saving the most lives possible. This goal is reflected in triage protocols designed to determine who receives priority in allocating scarce resources. In theory, reallocating ventilators from chronic care patients arguably serves this goal if the ventilator can be used to save multiple hospital patients over a period of time. Some ethical and legal guidance argues that it may be justifiable to withdraw ventilator support from a patient whose condition is not improving so that the ventilator can be used to save others who are more likely to benefit. This is largely based on the principle that there is no ethically or legally significant difference between withholding and withdrawing life-sustaining treatment as part of an appropriately justified and fairly applied rationing plan.
However, such guidance usually applies specifically to triaging patients who have come to an acute care facility during the extant emergency and does not extend to long-term care patients in other facilities. New York state’s 2015 ventilator allocation guidelines, for example, considered but ultimately explicitly rejected including chronic care patients in the triage guidelines (unless they arrive at an acute care facility). The New York guidelines determined that including chronic care patients in the triaging plan would conflict with the ethical requirement to defend vulnerable individuals and communities.