WHO Lives And WHO Dies: Italian doctors are faced with a horrible task

Conditions are dire in Italy.  The resources and medical personnel needed are insufficient for the task.  The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has told them to treat patients as if they were in a war zone: Treat those who are easy to save, and give palliative care to the rest.

This was preventable, but politicians kowtowed to China for money.

The Atlantic: The Extraordinary Decisions Facing Italian Doctors

There are now simply too many patients for each one of them to receive adequate care.

Now the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has published guidelines for the criteria that doctors and nurses should follow as these already extraordinary circumstances worsen.


“Informed by the principle of maximizing benefits for the largest number,” they suggest that “the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care.”

The authors, who are medical doctors, then deduce a set of concrete recommendations for how to manage these impossible choices, including this: “It may become necessary to establish an age limit for access to intensive care.”

Those who are too old to have a high likelihood of recovery, or who have too low a number of “life-years” left even if they should survive, would be left to die. This sounds cruel, but the alternative, the document argues, is no better. “In case of a total saturation of resources, maintaining the criterion of ‘first come, first served’ would amount to a decision to exclude late-arriving patients from access to intensive care.”

In addition to age, doctors and nurses are also advised to take a patient’s overall state of health into account: “The presence of comorbidities needs to be carefully evaluated.”

The doctors will be forgiven for choosing who lives and who dies.  Those who put them in this situation should never be.


  1. Darrell Johnson says

    Just for clarification, are you suggesting that having the disease get into Italy was preventable or that the fast spread of it was?
    If the latter then I think you are probably correct. I think we are looking at the same situation here in the US. When we should have been taking actions to slow this down our “leader” was basically saying not to worry about it.
    Don’t get me wrong, by the time the first case got to the US it seemed pretty clear this wasn’t going to be a battle we could win. However, as I think you are pointing out, it’s not a matter of if we can win, it’s a matter of how badly we are going to lose.
    My guess is that even with preventive measures you are still going to see close to the same number of people come down with this. However, it would slow down how fast it spreads. That delay makes a huge difference in regards to how many are showing up at the hospitals at any given time. And we need look no further than the story you quoted in order to see the significance of that.

    • says

      Pardon me for flogging Taiwan again and again, but the government was testing people incoming before Beijing even admitted there was a contagion. All incoming people since January have been screened and quarantined. Of the 80 cases, roughly 2/3rds were contracted outside the country, the rest passed to family, friends, neighbors, etc. The lone death was a taxi driver who unknowingly had a sick passenger.

      For over a month Italy didn’t screen and neither did the US as people went in and out. Two days ago, a thousand passengers were released off a cruise ship in Florida. Some of them had tested positive, none were quarantined. Who knows how many carriers have come in and how many they passed it on to?