These are challenging times for all. We hope and pray the Corona virus pandemic resolves soon, but we are worried that it may not. The physicians, nurses, and other health care professionals who care for us are worried that there could even come a time when they do not have enough life sustaining medical equipment to treat every patient who comes to them. They have been worried about this problem for years and have developed plans to help them decide who would receive life-sustaining treatment and who would not. They do not want such a profound decision reduced to the isolated opinion of any one physician in the moment.
We are writing to make you aware of a resource that health care professionals will be using to make decisions, should demand for medical services exceed supply. The North Texas Mass Critical Care Guidelines for Adults and Pediatrics guide health care professionals to objective medical criteria rather than subjective opinion should they be required to decide who will receive treatment and who will not. The Guidelines cannot address the current inequities in wellness or access to health care that plague our communities. We aspire to a future world in which the benefit of these criteria can be shared fairly and justly. For now, the Guidelines can only ensure that once someone is in the hospital system, treatment will be offered based on objective clinical criteria.
The purpose of this letter is to make you aware of the existence of the Guidelines and familiar with the guiding principles behind them so that you can offer spiritual support to health care providers who have to make these painful decisions, as well as to individuals and families who will have to find their way when they are told that providers have exhausted their options for medical treatment.
The principles behind the Guidelines are first, to save as many lives as possible when demand for medical services is greater than the available supply; and second, to prohibit discrimination in delivery of those services.
Functionally this means that people won’t receive or be denied treatment or maintenance of treatment because of who they are, how much money they have or any other social criteria. Access to and maintenance of treatment is based on objective physiologic criteria—the Sequential Organ Failure Assessment Score (SOFA Score). SOFA scores don’t take into account disability status, age, sexual identity etc. and assume acute circumstances.
Every hospital in North Texas has been working hard for weeks to prepare for and try to prevent the need to make hard choices, but if they must be made, they should be made on objective criteria. There are some who say that doctors shouldn’t make any choices about allocation of resources—but not making a choice is a choice. Experience teaches that more lives will be lost, and more discrimination will occur if decision makers do not follow the Guidelines.
Every hospital and county medical society in Dallas, Fort Worth, Denton and Collin Counties has pledged to follow the Guidelines, as well as other hospitals throughout the state. To date they have not been adopted statewide.
We know how much fear is present in our society right now. As faith leaders we should encourage everyone to support and trust our physicians, nurses, hospitals and everyone in the health care system as they work to save as many lives as possible.
SUGGESTIONS FOR WAYS YOU MIGHT LEND SUPPORT:
Reach out to individuals in your congregations and communities who could be impacted by implementation of the Guidelines. Consider those who are critical care specialists, hospital administrators, members of hospital boards, medical ethicists who may be asked to sit on review panels, health care workers who may be providing non-coronavirus-related medical resources—anyone who should understand why these guidelines are so important. The outreach could include an explanation of the need for the Guidelines in a time of real scarcity, an explanation of why you support them as a faith leader, and the assurance that you are available to support these individuals as they fulfill their responsibility.
Prepare a statement of support to your congregation or community that would be ready to go out to members if the point is reached where the Guidelines need to be implemented, explaining the guiding principles and why you support them.
Develop the spiritual resources that will be most helpful to you and your community when medical resources are exhausted.
Please share any additional suggestions you have. We also invite you to share any statements you prepare, or any other information or questions. We hope you will also familiarize yourselves with the attached resources.
Dallas County Medical Society has more information on the Mass Critical Care Guidelines.
Texas Medical Association has a Texas-specific information page:
This is the local go-to site and phone # for local questions about getting care:
Dallas County Health and Human Services
2377 N Stemmons Fwy Ste 600
Dallas, TX 75207-2705
Phone: (214) 819-2101
The Centers for Disease Control and Prevention site below has numerous downloadable handouts for patients, including ‘what to do if you are sick,’ in a dozen languages:
ON FRIDAY, APRIL 3 THE DALLAS MORNING NEWS RAN A STORY ON THE NORTH TEXAS MASS CRITICAL CARE GUIDELINES:
North Texas has a plan if hospitals become overwhelmed with coronavirus. Mass critical care could force very tough decisions, which is why we have to flatten the curve.
THE STORY WAS ACCOMPANIED BY THREE COMMENTARIES ON THE EDITORIAL PAGE BY PHYSICIANS AND CLERGY INVOLVED IN DEVELOPING THE GUIDELINES AND COMMUNICATING WITH HOSPITALS AND COMMUNITY GROUPS ABOUT THEM.
N. Texas doctors developed guidelines to determine what to do if hospitals are overwhelmed: The patients most likely to benefit from care would get priority
By Robert Fine, Mark Casanova, and John Carlo
Hospital guidelines will ensure coronavirus patients are treated fairly, but poverty puts people at greater risk: Loving our neighbors means taking serious precautions for them now.
By Richie Butler
Faith leaders can help prevent health care rationing by canceling in-person gatherings: Our communities need more from faith leaders right now, but not in the traditional ways.
By Nancy Kasten
On Saturday April 4 the DMN published this follow up opinion piece:
North Texas treatment guidelines are important, but they won’t fix inequities.
By Frederick D. Haynes
On Monday, April 6 an additional editorial was published about the Guidelines:
North Texas hospitals will ensure equity and fairness if they must ration coronavirus treatment.
By Brian Williams
God bless us all, now and always, and may this crisis ultimately lead to a more just and healthy community.
Rabbi Nancy Kasten
Reverend Dr. George Mason
Imam Omar Suleiman