Physicians play a substantial role in facilitating communication regarding life-supporting treatment decision-making including do-not-resuscitate in the intensive care units. Physician-related fact...

Early in my career as a neonatologist, I was called into the hospital for a newborn who would not stop crying. Screaming, really. When I entered the unit, I was greeted by a loud, shrill, distinctive cry. After hearing the history and examining the baby, I just stood there for a while, watching and listening. It took some time, but eventually, I noticed a subtle regularity, a rhythmicity. I took off my watch, placed it on the bed next to the (...) child, and found that the crying briefly grew louder about every six or seven seconds. This baby was having an atypical seizure. This preliminary diagnosis was followed by a conversation with the parents and a neurologist, transfer to the nearby academic center for an extensive evaluation, and the eventual demise of the child from a poorly understood disease. About a year later, I walked into the same unit and heard a cry I had heard only once before. I looked over to see the same mother at a newborn's bedside, with tears in her eyes, looking back at me. She knew what the coming days held for her and for her second child. That was over twenty years ago, but two images, or moments, remain with me. One is the watch on the bed next to the first baby; the other is the mother's expression of sadness the morning the second child was born. The image of the timepiece is perhaps instructive. (shrink)

The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the protocol, summarize the protocol, and discuss the major ethical challenges (...) encountered, along with our answers to the challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments.We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the pandemic and similar public health emergencies. (shrink)