In the midst of all of the cautious suggestions of “good news” in New York City as the pandemic appears to have reached a plateau, other places are only now starting to ramp up toward critical levels where their health care services are being overwhelmed. One such hotspot is in Massachusetts, where Boston Medical Center’s ICU is overflowing with patients and it’s getting hard to find a ventilator for those in the direst straits. The Boston Globe reported that some ambulances headed for the hospital were temporarily diverted to other facilities over the weekend because there were simply no critical care beds available.

Bracing for the worst, the state government announced that it was developing and issuing new guidelines as to how scarce resources will be prioritized. Described as a “gut-wrenching” decision, hospitals that run short of ventilators and other critical care equipment and supplies will need to assign a score to each patient based on how likely they are to survive. The people with the best scores will get the best care while others may be left to… you get the picture. (Boston Globe)

The guidance, which is not mandatory, asks hospitals to assign patients a score that gives preference to healthier patients who have a greater chance of surviving their illness, and living longer overall. It gives additional preference to medical personnel who are vital to treating others, and to women further along in pregnancy. In the event of tie scores, younger patients are given priority.

“There is a great sense of urgency,” said Dr. Robert Truog, director of the Center for Bioethics at Harvard Medical School and a pediatric intensivist who was part of the group that helped develop the guidelines. “We realize this all needs to be in place soon. It’s very important to have current guidelines that provide very concrete advice to hospitals about how to allocate these resources.”

State officials asked a small number of physicians and bioethicists from hospitals across Massachusetts, including Truog, to develop detailed recommendations for allocating ventilators and intensive care beds, which the group did over the weekend of March 27 to 29.

As described above, there are some special cases and exceptions in the rationing game. If you are a worker in the healthcare field you will automatically receive a high score. Pregnant women can also go to the head of the line. But beyond that, the prioritization works pretty much as you would expect. If you are younger and generally healthier, with a greater expectation of surviving the worst the novel coronavirus can dish out, you’ll be prioritized for a ventilator and other critical care equipment. If you are older or have other, underlying health problems complicating your situation, you’ll be closer to the end of the line.

Some of the exceptions make sense in a brutal sort of way. Perhaps all of them do. You need your healthcare workers to survive in the largest numbers possible during a pandemic like this, otherwise, there won’t be enough people to operate the equipment and you’ll lose more patients anyway. And using the equipment for someone with a higher likelihood of dying while a person who might readily be saved is gasping for breath isn’t logical. And please keep in mind that I say this as a person in his sixties with a history of previous respiratory problems, so I’ll probably be assigned a pretty low score.

But even if there is a sort of brutal “logic” to all of this, it’s also worth keeping in mind that these sorts of guidelines are describing rationing, plain and simple. People who talk about socialized healthcare, Medicare for All and similar systems should be familiar with the idea. Also, the people pointing to Canada’s “free” healthcare system should be aware that rationing is the rule of the day there.

Under any of these systems, if you are sick you may be facing a long wait before you can see a doctor. And if there are others who are “prioritized” ahead of you, well… best of luck. If nothing else, hopefully, your family will qualify for a free state funeral.