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Commentary

NDC Perspective: A committee to determine who lives and who dies?

The right to life is an inalienable right, enshrined in the Constitution of Grenada. This inalienable right is enjoyed by everyone in Grenada, no matter your age, health status or standing in society. Minister Steele’s announcement of a plan to set up an ethics committee to decide who gets care when hospitals fill up as COVID-19 cases increase, has left many people feeling morally troubled, even distraught.

The Minister of Health provided no details about the plan, but his statement reflected a practice in other countries, where life-saving care is withheld from people based on their age, or their chances of survival based on chronic illness they may have. While deciding whether a person will benefit from further treatment or not is nothing new for doctors, allocating limited resources to benefit those who doctors believe are likely to survive is not easy or ethical.

Undoubtedly, the rise in COVID-19 cases is putting a strain on resources at the hospitals, stretching their services to breaking point. This is something that the Minister and his entire team ought to have anticipated and prepared for. Unlike other countries, we were lucky in Grenada to have had a long time to prepare for community spread, which given all the circumstances, the administration must have known, was going to happen. We had more than a year to prepare special facilities for COVID-19 patients. It is just not acceptable now for the Minister to be caught prioritizing who lives or dies. Is this the story we want told to future generations?

To begin with, setting a threshold for who should or should not receive care is unethical. We as a people believe that where there is life, there is hope. While predictive tools do provide estimates of the prognosis of a disease, they are unable to reliably predict who would respond well to treatment and who would not.

The common argument that younger people are more likely to survive the COVID-19 disease than seniors is not necessarily a sound one. As we have already experienced, both young and old patients are vulnerable and can become seriously ill or die. Therefore, the general notion that young, healthy patients are most likely to survive is misguided.

Our focus and that of our leaders should be putting proper hospital facilities in place to save lives, not putting systems in place to decide who dies. Has the administration taken any steps to get help from the United States to set up field hospitals as they did for the people of Trinidad? The NDC strongly recommends this to the government.

Indeed, it is a challenging time for the health authorities, but its leaders can and must do better. They should not write a policy to make it okay to decide who lives or dies. Rather, they should do their best to save as many lives as possible, adhering to the principles of social justice. Medical leaders have a moral responsibility to advocate for vulnerable patients. For this reason, they must consider their rights and the fact that age, health conditions or standing in society do not alter a person’s entitlements.

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In a society governed by an ethic of care, the last thing the health authority should want is for the people to perceive they are being discriminated against because of their age, health conditions or who they are. When health authorities discriminate against their people, trust is eroded, which could take decades to regain. While it can be challenging to find the right balance between saving lives and prioritizing the allocation of limited resources, the NDC says that it is still not too late to use various strategies to optimize the work in dealing with this crisis.

As we have recommended before, there should be more strategic planning to shift resources. Increase the number of personnel at the hospital using volunteers and paid help from among the many trained, unemployed medical personnel in Grenada; embrace an inclusive, collaborative approach, involving all stakeholders; and secure more equipment including PPE. Finally, consider a designated COVID-19 hospital at Meribeau or some other suitable location. It is hazardous for other sick people to be housed at the same hospital with COVID-19 patients.

In March 2020, NDC recommended that in preparation for community spread, specially designated isolation centers be identified where the infected from large households who do not need hospitalization can be isolated. We believe this measure can help stem the spread among families.

We are particularly concerned that approximately 60 nurses and doctors are impacted by the virus and no special accommodation has been made for them or their peers who must work long and grueling hours.

Mr. Minister, a policy that decides who would be denied medical care creates an ethical dilemma because treatment is not equally available to all Grenadians. Such policy would be unjust and shortsighted. This is a good time to reflect on the Biblical story of Haman who was hanged on the gallows he built for Mordecai. Someone you love could be one of those forbidden care by your own medical ethics committee. We value the lives of all our people. Let’s talk about saving lives, not taking lives.

NDC