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Elderly people could carry a card saying, 'If I fall ill and am taken to hospital, treat young people first.'

29 Comments

How many life-and-death decisions does the average doctor make in a day? Many, we may presume, even without statistical evidence. They begin even before treatment. Who gets treated? On whom would treatment be wasted? That, too, must be decided, and it’s an agonizing decision, the more so now, with medical systems, personnel and equipment stressed to the breaking point.

You’re an intensive care unit physician. Two patients are brought in, one young, the other old. You can’t treat both. Should the young one get priority? For obvious reasons, yes – and yet, the elderly too has claims on life.

How much simpler the choice is – and how much less the emotional toll on the hyper-strained physician – if the elderly patient carries a card saying something like, “If I am brought to an emergency ward, treat a young patient ahead of me.”

Shukan Post (May 22-29) introduces an Osaka doctor’s experiment with such cards, and asks whether Japan as a whole should do something similar.

The COVID-19 pandemic has exposed woeful weaknesses in Japan’s medical infrastructure. Germany has 29 intensive care unit beds per 10,000 population. Italy has 12. Japan has 5. Artificial respirators are in correspondingly short supply.

That gives the general idea. Not everyone who needs treatment can be treated. Who is taken, who refused? Cardiovascular doctor Fuminobu Ishikura began distributing cards to the elderly under the stress of the circumstances. The cards are not legally binding, but potentially at least – it’s too early in the experiment to assess how they’re being received – they smooth the triage process.

“As a young doctor,” Ishikura, 64, tells Shukan Post, “I worked with heart transplant patients; also in emergency medicine. Back then, we had the technology to do heart transplants, but ‘brain death’ was an ethical hurdle Japan had yet to clear.”

Brain death was not enough – the heart had to stop for death to be official – by which time the heart was no longer suitable for transplant. “I watched young patients die before my eyes,” Ishikura recalls, “who could have been saved by a heart transplant – had a heart been available.”

The system now in effect recognizes brain death as death if the patient carries a card signifying consent.

“There are arguments on both sides,” Ishikura concedes, but considers this one decisive: “Past 60, the immune system weakens. You may think you’re fine, but you could die any time. With resources as strained as they are, maybe it’s time to think about giving the elderly the choice of allowing younger people with their whole future ahead of them to be treated first.”

That’s a start but it doesn’t go far enough, Shukan Post hears from noted journalist Akira Tachibana, 61. The prior treatment of younger patients should not depend on the self-sacrificing generosity of the elderly, he says. He advocates precise rules that apply to everyone, proposing Holland as a model. Under the pressure of the pandemic, Tachibana says, Holland lowered the maximum age of eligibility for intensive care from 80 to 70. Individual facilities in Amsterdam decline to admit patients deemed unlikely to live more than a year, or those with certain chronic illnesses.

How do elderly people in general feel about that? Answers no doubt span the spectrum. The arguments in favor are undeniable. So, unfortunately, is at least this one which reflects hesitation, though not outright disagreement. It comes from economic writer Katsuhiro Miyamoto, 75, who tells Shukan Post, “Life is precious to all of us, young and old.”

© Japan Today

©2020 GPlusMedia Inc.

29 Comments
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I disagree, all life is precious and valuable.

The decision on who to treat first should be based on objective triage procedures.

Not some subjective calculation based on whose life is worth more.

12 ( +15 / -3 )

Instead of debating who's life is more precious, why don't you as a government create more hospitals, more medical universities so the people would never ever be in the retarded position to even ask or consider that question.

Desgusting topic.

12 ( +16 / -4 )

Perhaps foreign people living in Japan should also carry a card saying "If I fall ill and am taken to hospital, treat Japanese people first."

5 ( +9 / -4 )

...or the country could decide to recognize DNR requests (do not rescusitate).

8 ( +8 / -0 )

I guess people could say this is voluntary, but social pressure to conform could mean that some older people feel obliged to carry a card like this one, whether they really agree with it or not. Also, most people over 60, even those with comorbidities, can look forward to 20+ years of life. That's not to be given up lightly.

7 ( +7 / -0 )

How about “If I am brought to an emergency ward, I want your best doctor working on my case.”

14 ( +14 / -0 )

All people needing treatment should be getting treatment.

11 ( +13 / -2 )

I didn't even know there where that many people in Japan willing to donate organs.

1 ( +1 / -0 )

Or a card that says "Treat me like a panda. I'm an irreplaceable asset."

10 ( +10 / -0 )

It could also be said, that since the old people have paid in more money than younger people, they should be at the head of the line.

9 ( +13 / -4 )

Not necessarily Zichi. There are plenty of old people who have gone through life sponging off the state.

-7 ( +4 / -11 )

All people needing treatment should be getting treatment.

Agreed.

The vitriol against older/elderly people is quite shameful whenever it raises its ugly head.

10 ( +12 / -2 )

In the hypothetical situation in that you have to chose witch one to treat first.

You go for the elder one first. The young can wait.

To ignore a patient its a criminal action, and will put you in serious legal troubles.

We were doing like that in Ambulances, at my home country.

2 ( +3 / -1 )

Instead of debating who's life is more precious, why don't you as a government create more hospitals...

Indeed, a little while ago there was an article on JT about the occupancy of hospital beds in Japan. It was shockingly high considering the very low infection rates in this country.

I really hope they prepare now, instead of waiting for the next wave to hit in autumn to start having countless meetings to discuss how to handle it....

2 ( +2 / -0 )

We seem to be missing the practical side. All resources, of any physical sort, are limited. There's no way to make them unlimited. The goal is to handle normal situations with a system that can stretch, perhaps 10% more to handle extraordinary situations. Having 50% more for that stretch which comes once every 200 yrs is too wasteful to maintain. It would be crazy.

The doctor in this story knows this. He's trying to be practical.

All medical facilities have people trained to take an initial assessment for the patient's issue(s) and adjust where they are placed in the cue based on that. Doctors, nurses, everyone working in healthcare all know that people die every day and they do their best to prevent it.

Not having this hard discussion is like the ostrich hiding his head in the sand. Adults need to address difficult situations when we know the ideal outcomes aren't possible in every situation.

It is not despicable to have the discussion.

1 ( +2 / -1 )

The good thing about keeping the curve flattened is that health providers do not have to choose between who to try to save, and who to not try to save.

1 ( +1 / -0 )

KniknaknokkaerMay 15 02:21 pm JST

Not necessarily Zichi. There are plenty of old people who have gone through life sponging off the state.

-4( +2 / -6 )

Yeah they're in the Diet, and I would be entirely okay if they were required to carry those cards.

5 ( +6 / -1 )

Kniknaknokkaer

Not necessarily Zichi. There are plenty of old people who have gone through life sponging off the state.

Link proving your discrimination. How are they sponging off the state?

More old people have paid into the pension and health schemes than didn't otherwise they wouldn't exist today.

3 ( +4 / -1 )

You first.

0 ( +1 / -1 )

The health care and pension finances in Japan are in deficit and have been for decades. The payments made by old people when they were young went to old people then. Old people today live off the taxes of the workers today, some of them being young. It is a pay as you go system. So using your reasoning working people who pay for the healthcare system should get priority over old people who are coasting financially and are basically collecting welfare. This is how it works in reality. The problem today in Japan is that fewer people are working as the population goes down so for every old person being supported by the government there are only 3-4 workers paying for the him or her. And it goes without saying that old people consume a huge proportion of healhcare resources especially in their last year or so.

-4 ( +0 / -4 )

Perhaps foreign people living in Japan should also carry a card saying "If I fall ill and am taken to hospital, treat Japanese people first."

I think Kimi Onoda made that suggestion already.

0 ( +0 / -0 )

The payments made by old people when they were young went to old people then. Old people today live off the taxes of the workers today, some of them being young. It is a pay as you go system.

That's correct as far as it goes, but you omit to mention that the elderly of today are the boomers; when they were paying in to the system there were far fewer people receiving than were paying in, and there was a huge surplus; that surplus should have been put away/invested for the time everyone knew was coming when the number of recipients would rise as the boomers became pensioners. Instead the politicians of the time (many of whom are still around clogging up the corridors of power) squandered the money away on feel-good projects, empty concrete boxes, roads and bridges to nowhere - juicy fat contracts for their construction company buddies/political donors.

old people who are coasting financially and are basically collecting welfare

The pension is not welfare; people are getting what they were promised when they were paying in all their working lives. It's a social contract between the government and the people.

Invalid CSRF

8 ( +8 / -0 )

There are arguments on both sides,” Ishikura concedes, but considers this one decisive: “Past 60, the immune system weakens. You may think you’re fine, but you could die any time. With resources as strained as they are, maybe it’s time to think about giving the elderly the choice of allowing younger people with their whole future ahead of them to be treated first.”

Anyone at any age could die at any time. I think if I got here first then treat me first. You can janken if we get there at exactly the same time. I am not one for false selflessness so if one of us has to take one for the team then I hope to be on next year's roster. I would make sure to put a nice wreath on your tombstone every year though.

1 ( +1 / -0 )

Hospital treatment is not based on first come , first served.

It is based on need-the more severe the case the quicker the treatment.

2 ( +2 / -0 )

You don’t go to a hospital to not be treated.

1 ( +1 / -0 )

The over 60s are still human beings. This doctor appears to have left his empathy at home. Medical treatment should be provided on the basis of need. If treatment will cause more harm than good, or there’s a do not intervene request in place that’s all well and good. Otherwise need must be the humane deciding factor.

The economic contribution argument doesn’t wash either. The majority of pensioners aren’t just surviving on the state pension, most have private or company pensions and savings too. A fair chunk also go on to work well into retirement. The elderly are by no means “coasting”, the vast majority continue to contribute.

1 ( +1 / -0 )

Elderly Japanese for the most part, have it too good to want to give up their spot on earth for anybody.Hence they live so long.

-3 ( +0 / -3 )

This is abhorent ageism at its worst.

0 ( +0 / -0 )

In UK, hospital isn't treating cancer patients regularly like they used to, due to Covid-19 or any flu patients.

And government has already ordered the companies such as Private Care Homes to put off the names of the cancer patient from the list so that they cannot have self isolation or weeks off and make them keep working because they're already sick and no use to treat them as same level as healthy people.

9/10 people don't know about this. This should be known globally and make action against it.

0 ( +1 / -1 )

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