11 Jun 2020 - by Stephen Pickard
We have all breathed a sigh of relief that we might have dodged the Covid19 bullet. Our governments – and New Zealand - acted quickly, cooperatively and generally smartly to get us to an enviable position. But the pandemic is not over yet.
We are entering winter and the flu season. At the same time we are beginning to ease the lockdown. The hope is that the surge in testing, Personal Protective Equipment, Intensive Care Unit and ventilator capacity, combined with rapid transmission tracing supported by the COVIDSafe App, will allow us to manage the inevitable increase in infections. How far and how fast we can go in easing the lockdown is under active consideration. But there is likely to be an uptick in the death rate, particularly among the vulnerable, as a price for getting the economy going again.
All of these decisions have huge ethical dimensions to which Christianity is relevant, but the Churches have been largely notable for their absence from the public ethical debate.
We must not forget that we saw other countries face the dilemma of how to ration access to health support when their systems were facing acute shortages of equipment, staff, beds and ICU capacity. In part this was because stocks of acute health supplies and equipment had not kept pace with rising risks, and in some cases had even been run down through economies. But either way the results were tragic.
In Italy there was active consideration of excluding those over 70 from access to ventilator support, in the UK staff in care (nursing) homes were told not to bring ill residents to hospital and deaths in care homes were not included in national statistics until recently. In the US at least one state allegedly hinted that the severely intellectually or physically disabled should perhaps not be allowed access to scarce ICU beds.
In Australia we haven’t faced the appalling need to take decisions over who gets access to the next ventilator when not all can be helped and some must die – and hopefully this time we never will. It was not possible to predict this particular pandemic for this year, but the world was well aware that a pandemic, probably from a zoonotic disease, was increasingly likely as population densities and movements soar and habitat for wild animals reduced. This will not be the last pandemic we see.
What insight can our Christian faith offer us, and the world, about how to make these decisions? Should we have age limits? Should we consider the “quality” of lives being lived? Should the disabled be placed lower in the queue? Should the young and parents be advanced?
Christ came for all - the poor, the crippled, the old, the children, the sick and the outcasts. His mission was focused on those with broken lives. He didn’t ask - is this life useful? If I save Lazarus will he live for long? He did not set arbitrary age limits on access to his saving actions, nor did he deny the disabled or mentally afflicted. Neither should the health professionals when judging who should get their life saving support. Health professionals should only consider the extent to which life support will be effective in recovery from coronavirus. Age might be an indicator in deciding the prospects of benefit from ventilator support but it should not be a basis of exclusion in its own right. Disability should never be a criterion for excluding access to care.
Triage guidelines should explicitly rule out discrimination on the basis of arbitrary age limits and disabilities. Age and disability really have to be on the list alongside race, gender, religion, sexual orientation and social standing as matters that are not relevant in consideration of who should access or continue benefiting from life support. Otherwise doctors will be making judgments about something akin to "social utility," which is a judgment made by totalitarian states, not democratic ones and certainly not by Christians.
The patient’s wishes, and those of their family where the patient is incapable of expressing those wishes, are already an important consideration by doctors in commencing and continuing intensive care treatment.
Again Christianity is relevant. The second great commandment “Love your neighbour as yourself” lays a loving burden on all Christians. Even when you are gravely ill you must think of others who are also ill.
Christ’s life was one of sacrifice. Christians will also bear this in mind. Some will form the view that it is important that ICU and ventilator support should not be simply a way of prolonging their dying and that they would rather, in circumstances of severe shortages, either not access support, or have it withdrawn and enter palliative care.
But this leaves us with difficult dilemmas.
What if the emergency department holds a fit and healthy 83 year old and a 38 year old diabetic woman pregnant with her second child – both in desperate need of ventilator support? Can we consider the years of probably healthy lives saved if the preference is given to the mother with child to be a form of Christian stewardship of the Creation? Perhaps so.
But what if the 83 year old had already been granted access to the ventilator when the mother with child arrived? Should they be asked to surrender their place? If they decline should they have their support withdrawn against their wishes and in full knowledge that this is almost certain to result in death? Would withdrawal of ICU support be an infraction of the commandment “Thou shalt not kill”? Perhaps so.
These dilemmas might now seem hypothetical – but they have been only too real in other countries. We have to think about them, as Christians, now, so we are prepared for the - only too likely - trials ahead. We must make sure our governments never allow our health system to fail to prepare and rehearse for the risks ahead.