4 ms·
No, that's not it. In the situation where they are on ECMO, and their removal from ECMO would result in their certain death (as opposed to, say, their recovery
by margalabargala 3y ago
No, that's not it.
In the situation where they are on ECMO, and their removal from ECMO would result in their certain death (as opposed to, say, their recovery, or their transfer to a different life sustaining technology) then they should not be removed except with their consent.
That's an important piece of nuance.
- renewiltord 3y agoUnderstood. So in time, provided that such people exist in sufficient quantity and we don't avoid placing them on the machine, then we should expect that all ECMO machines will eventually be occupied. What happens to the next guy?
- paulcole 3y ago> What happens to the next guy? This one’s real simple! They die.
- renewiltord 3y agoJust a trolley problem in the end, eh?
- paulcole 3y agoYeah I mean it’s pretty obvious. If the resources that keep people alive are all taken and you’re not willing to take that resource from somebody using one, then the next person who needs one is going to be left out. So either we get OK with pulling the plug, build more of the machines, come up with a new idea, or be OK with people who need these things dying.
- nradov 3y agoBuilding more machines isn't sufficient. The limiting factor is expert human healthcare providers to operate the machines, and do the other things necessary to keep the patient alive.
- paulcole 3y agoOk so add “get more people” to the list of options…
- nradov 3y agoThis is complex work which requires extensive training, and very few people are capable or even willing to do it regardless of pay. Our resources are limited, and this is not the best use.
- paulcole 3y agoRight... so you don't do that and go with one of the other options. Like I said the first time...
- gcanyon 3y agoThink about it long and hard enough, and every problem becomes a trolley car problem.
- renewiltord 3y agoIndeed. All life is trade offs, which means it is interesting to me when people claim there are no trade offs. All resource usage competes with other resource usage.
- kmeisthax 3y agoBuild more ECMO machines before that happens?
- tsimionescu 3y agoIt's already happening right now. And also, it's not just a manufacturing issue, you also need to train more personnel, and find more space in hospitals for one.
- margalabargala 3y agoThey go into the next machine to be made. The scenario you describe happens if sufficiently many such people exist, and if they are all placed in machines, and the rate of new machine construction plus the rate at which the current patients die of other causes is higher than the rate at which such people are being born. I don't think that's a plausible scenario.
- tsimionescu 3y agoNot only is it a plausible scenario, it is the reality today. There are far fewer ECMO teams + machines than people who will die without it. In time this will improve, as technology advances and as more medical personnel are trained in maintaining one, but we are at the early stages and this conundrum happens all the time.
- renewiltord 3y agoIt is the current scenario. We have to dedicate both people and resources to this. Triage is a real thing. Resources are not infinite.