Rationing care is a surrender to death

That authorities in some hard-pressed areas are considering rationing likely strikes most Americans as ghoulish. How, for instance, does a patient “qualify” for a ventilator? How old is too old? In 2014, Ezekiel Emanuel, one of the architects of the Affordable Care Act and now an adviser to Joe Biden on coronavirus, declared that 75 was long enough to live. After that, people become “feeble, ineffectual, even pathetic.” But was Einstein? Verdi? Matisse? Or should the decision be based on health? Do we exclude a patient with multiple sclerosis? Or someone who is blind?

The instinctive resistance people feel to these questions was illustrated in a series of public forums after the 2009 swine flu outbreak, held by a faculty team from Johns Hopkins University. More than 300 participants were invited to weigh the possibilities of rationing. Lee Daugherty Biddison and Ruth Faden, organizers of the forums, recalled that participants rejected a simple first-come-first-serve model. Then they rejected a lottery system as too arbitrary. And they struggled to create an algorithm for rationing. In the end, the participants asked why it wouldn’t be better simply to build more hospital rooms or manufacture more ventilators in advance.