MONTREAL — Dr. Eugene Bereza calls it the "nightmare scenario": the possibility doctors in Quebec will have to implement a government protocol to decide who is admitted to intensive care and who will die.
Bereza, a professor of medicine and an ethics consultant at the McGill University Health Centre, reacted Tuesday to recent news that the province's hospitals could start using the protocol in a matter of weeks.
"We never anticipated this would happen to us in Quebec, or Canada, in a non-war context," Bereza said in an interview Tuesday.
On Monday, Dr. Lucie Opatrny, an assistant deputy health minister, told reporters that hospitals in the province had started to run training simulations involving the triage protocol for intensive care beds.
Health officials on Tuesday said the number of COVID-related hospitalizations rose by 61, to 1,497, and 221 people were in intensive care, a rise of 10. Later in the day, two hospitals in eastern Montreal asked people to avoid their emergency rooms because of COVID-19 outbreaks.
Canadian hospitals regularly ration care, Maxwell Smith, bioethics professor at Western University, said Tuesday. But that type of rationing is normal and involves deciding how quickly people see a doctor based on the urgency of their needs.
Rationing care because there aren’t enough resources to provide lifesaving treatment, however, is “a totally unique situation that we haven't faced in the past," he said in an interview.
Doctors and nurses are used to doing everything they can to help each individual patient, Bereza said, adding, "an extreme pandemic turns that completely upside down." If the protocol is implemented, the focus instead becomes saving as many lives as possible, with the available resources.
"Nobody's going to be happy implementing this, we're all going to be traumatized by it," Bereza said. "The reason we're doing it is because we think it's going to accomplish more good. It's the lesser of several evils."
The concern in Quebec, Bereza added, is less about a lack of beds or ventilators and more about having enough staff to care for patients with COVID-19. Quebec's protocol instructs hospitals to begin preparing to ration care when intensive care units reach 150 per cent capacity and to implement the protocol when they reach 200 per cent.
In a report issued Jan. 7, a government mandated health-care think tank said two-thirds of ICU beds in the Montreal area were occupied and warned that hospitals in the region would likely to run out of dedicated COVID-19 beds within three weeks.
The protocol is intended to prioritize patients with the best chance of surviving; patients who don't improve — or whose condition worsens — could be discharged from the ICU and taken off life support. Patients who may require a ventilator for a long period of time or who have a degenerative disease could also be designated a lower priority.
The document stresses that decisions cannot be made in a discriminatory manner or based on the "social value" of an individual's life. A three-member committee, consisting of two doctors and one person who is not a doctor, is tasked with making the decision. Members aren't provided with the patient's name, only their date of birth and their prognosis.
Frameworks such as the government's rationing protocol help ensure fairness, Smith said, adding that they help doctors avoid the "moral distress" of having to decide on their own who lives and who dies.
And while prioritizing patients based on their prognosis is the consensus view among bioethicists, Smith said, steps need to be taken, he added, to ensure that people who are disabled or members of racialized communities aren't discriminated against.
Jocelyne Saint-Arnaud, professor at the Universite de Montreal’s school of public health, said the protocol is intended to help doctors find a compromise between the needs of individual patients and public health.
“The authors of this protocol hoped it would never be implemented,” she said in an interview Tuesday.
Quebec reported 1,934 new cases of COVID-19 Tuesday and 47 more deaths attributed to the novel coronavirus, including 13 within the preceding 24 hours. It's the second day in a row — and the third day since Dec. 17 — Quebec has reported fewer than 2,000 new infections.
Health officials said they administered 7,058 doses of vaccine Monday, for a total of 99,510. They say no one in Quebec has so far received a second dose of vaccine. Quebec has reported 232,624 cases of COVID-19 and 8,782 deaths linked to the virus since the beginning of the pandemic.
This report by The Canadian Press was first published Jan. 12, 2021.
This story was produced with the financial assistance of the Facebook and Canadian Press News Fellowship.
Jacob Serebrin, The Canadian Press