This post is part of our monthly series featuring the experts of the Center for Bioethics community. The thoughts reflected in this piece are the authors’ individual, expert opinions and do not necessarily reflect the position of the Center for Bioethics nor the organizations with which they affiliated.
Sometimes the best way to share an idea with another person is by telling a story. In stories, we can see how characters develop and we witness the effects of their choices. Was a character a hero or a villain, or something in between? Were their choices harmful or helpful? Is the ending of the story good or bad? Stories help us make sense of how a person acted. Stories can be compared, and they can help make sense of what we should do not only as individuals, but also as a community.
Scott Quiner’s story is an important story. If you’re unfamiliar, Mr. Quiner was a 55 year old unvaccinated Minnesotan who contracted COVID in October of 2021. He was admitted to the ICU at Mercy Hospital on November 6, 2021, and on January 11, 2022, physicians and hospital leaders notified Mr. Quiner and his family that they intended to stop the use of mechanical ventilation on January 13, two days later. The Quiner family subsequently went to court to stop the hospital’s plan, and also publicized their disagreement through a podcast. A judge temporarily stopped the hospital from withdrawing the ventilator. On January 15 Mr. Quiner was transferred to a hospital in Texas; on January 22 Mr. Quiner died. Depending on who’s telling it, there are different heroes, villains, and victims. But no matter who tells it, it’s a sad story, with conflict and pain. However, Mr. Quiner’s story is not the only sad and pain-filled story that is being lived and written in our community as we endure this pandemic . There are many more tragic and pain filled stories that we believe are worthy of equal consideration.
Imagine you develop a stomach ache; it gets worse and worse, and you wind up in the emergency room. You have an inflamed gallbladder and need emergency surgery. Normally you would be transferred to a larger hospital, with specialists and equipment to provide the best care. Because of the scarcity of resources in the pandemic, you end up in the local emergency department for hours to days, with an overwhelmed nurse practitioner calling an overworked ICU specialist. Imagine having lung cancer and getting your surgery postponed indefinitely. Or being a nurse, required to leave your family and show up for work after testing positive for COVID, at a hospital that is adding more patients when you’re already short staffed, and where a patient’s family may even accuse you of killing their loved one after you’ve tried your best.
As doctors, nurses, and ethicists, we aren’t just witnesses to countless stories, we’re also in varying degrees characters and co-authors, sometimes even narrators.
As medical professionals, we believe that medical treatments can be an important part of a person’s life story. We believe that it’s a bad story and something has gone wrong when doctors and nurses perform interventions that patients do not want. We also believe that it’s a bad story and something has gone wrong when doctors and nurses are forced to perform interventions that are either ineffective or cause suffering without benefit, regardless of any kind of scarcity. Furthermore, we find it especially tragic when doctors and nurses are forced to consume scarce resources to perform these desperate death prolonging treatments in ways that result in other patients being denied a fair chance at life saving treatment.
Our individual choices and stories directly impact the stories of others. One person’s choice may be a cause of another person’s tragedy, and those involved often bear witness to these tragedies.
We hope for better stories in our hospitals. At the individual level, good stories are ones where doctors, nurses, patients, and their loved ones work together to find a common ground, where we both honor patient values and rely on the insight of medical experts without resorting to an adversarial process in a distant courtroom. At the community level, good stories are ones where we can boast that we faced hazards together, that we did the best that we could for each person affected, and that we did it with a shared kindness, grace, and courage, even in the face of death.
On January 19, 2022, frontline doctors from Hennepin Healthcare wrote a compelling piece for the Star Tribune that we agree with (“When death is coming, difficult choices are required,” Jan. 19). It is wrong to force doctors and nurses to do things that, as experts, they know are harmful and ineffective. It is also morally wrong to consume resources in irresponsible and ineffective ways, thereby depriving other individual patients a fair chance at recovery and resulting in a greater number of avoidable injuries and death. Finally, it is profoundly problematic if certain groups of people are more likely to suffer the effects of scarcity than others, such as people who live far from major hospitals, people with underlying conditions, or people who just lack the kinds of privilege that might come with money, access, and power.
We live in a community; we breathe the same air, and we go to the same hospitals. We all depend on the medical expertise of doctors and nurses when things go wrong with our bodies. The doctors and nurses we see at the hospitals are also our friends and loved ones outside those hospital walls. Every member of the healthcare team is trying to maintain conditions so that we can all receive the best care and have a fair chance to get that care, even while we are running out of resources.
We hope that we can write and co-author better stories. Beyond asking you to do certain things like getting vaccinated and wearing masks, we are also asking you to partner with us in writing better stories for both the individuals who come into our hospitals and our larger community; stories worth retelling as examples of how characters make good choices with kindness, courage, and grace.
Joel Wu, JD, MPH, MA, HEC-C, is a Center for Bioethics’ Clinical Ethics Adjunct professor and a senior lecturer in the Division of Health Policy and Management at the University of Minnesota’s School of Public Health. Wu’s primary role is as a clinical ethicist for the MHealth Fairview and the University of Minnesota Medical Center (UMMC), where he provides clinical ethics consultation. He is a Co-Chair of the UMMC Ethics Committee, Ethics Lead for MHealth Fairview, and member of the MHealth Fairview Ethics Council. Wu also teaches courses at the intersection of clinical ethics, public health ethics, and public health law. In addition to clinical ethics consultation, Wu’s recent work has been focused on ethics issues related to the COVID-19 pandemic, with an emphasis on issues concerning the fair allocation of scarce resources in society and the balance of individual interests and common goods during a public health crisis. Wu is also a contributing member of a multidisciplinary team examining the problem of the use of less-lethal weapons, police brutality, and systemic racism in society. Learn more.