Terrible choices ahead

IN THE FILM Sophie’s Choice, a mother arriving at the death camp of Auschwitz is forced to choose which of her two children will be gassed and which will proceed to hard labour. To avoid both being killed, she chooses her son to survive and her daughter to be sent to her death.

We could be in store for many such dilemmas here in the not-too-distant future.

This is the grim implication of the fact that intensive care units (ICU) – in both Trinidad and Tobago – have now been overrun with covid19 cases. But instead of families being left to decide which of their loved ones will be given access to life-saving medical treatment, it will be for anonymous state officials to decide, effectively, who will live and who will die.

While the Government has already boosted the number of ICU beds, it is not clear how sustainable adding more beds will be, especially if numbers continue to rise.

Health Minister Terrence Deyalsingh said last Saturday, given the country’s limited capacity and resources, if the ICU numbers continue, doctors may have to triage patients and decide who will get access to that level of care.

If they are not already in place, the parallel healthcare system will have to be supplemented with special ethics committees that will have power to implement guidelines for managing the intake and care of critical cases.

Ethical considerations have always been an aspect of treatment in individual patients, ranging from questions about the appropriate course of action given a patient’s beliefs, advance directives in cases where patients are no longer conscious or compos mentis, and issues relating to quality of life – particularly with newborns.

However, the sheer number of covid19 cases will demand an additional layer of oversight and a body that can, with its bird’s-eye view, implement a suite of consistent guidelines to help effectively manage scarce resources.

Such measures have already been put in place in countries around us. In September, Grenada was forced to establish an ethics committee to triage admissions.

“It’s time that we put that in place,” the country’s health minister, Nickolas Steele, grimly announced back then. “I do hope that it is never used.” Other islands, like Jamaica, have also been witness to harrowing scenes of hospitals being overrun, bringing the necessity for such measures to the fore.

Meanwhile, anti-vaxxers in TT have cried discrimination over education, employment and safe zones to date. They have withheld their children from receiving vaccines.

It may well be that as a result, we are about to see the consequences of putting irrational considerations ahead of the most precious right of all: the right to life.

It is tragic that, as a population, we have allowed ourselves to reach this point.

The choice was simple: get vaccinated. Now, other people more susceptible to this virus will be stripped of any choice at all.


"Terrible choices ahead"

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