Views & Reviews Personal View

Priority patients in a pandemonium

BMJ 2009; 339 doi: (Published 19 August 2009) Cite this as: BMJ 2009;339:b3321
  1. Robert Wheeler, consultant paediatric surgeon and honorary senior lecturer in medical law, Southampton University Hospitals Trust
  1. robert.wheeler{at}

    Should swine flu mutate into a more sinister disease than its present form, very large numbers of sick patients will present at the reception of your practice or your hospital demanding treatment. Some of them may be your colleagues or their families. Will you give them priority?

    While the available facilities exceed the demand, all patients will doubtless be dealt with in an orderly manner. But when the numbers exceed the facilities, triage will be implemented, selecting those who will benefit from treatment in favour of those in whom treatment may ultimately be futile. This is a well understood process, dating back through centuries of warfare, and is considered a measured response to a lack of resources. But warfare tends to generate a wide spectrum of injury severity. This makes differentiation between those who can wait for treatment, those who cannot, and those for whom treatment will make little difference relatively straightforward, at least in theory. However, an overwhelming …

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