Triaged Medicine, The Veterinary Professions Answer to Who Gets What In Times Of Scarcity.

One of the hot topics on the human side of healthcare is how to manage limited resources in the face of an overwhelming need and critical shortages?

The scenarios range from anything like a massive flu pandemic where things like life saving medications or ventilators are in shorter supply than the demand requires.

Another would be oxygen in areas where natural disaster has hit. Think about a hurricane hitting an island and the power is lost. People need supplemental oxygen for surgery, respiratory disease, infection, burns, etc. What happens when the ability to provide supplemental oxygen is at a place of rationing?

What about food? Shelter? Medications? Or any kind of medical, health or supply that the masses need in a catastrophe? What about epinephrine pens that are now 800 times more expensive than it was a few years ago and needed in seconds to save lives? What about generic drugs that are no longer profitable (enough) to manufacturer but would be basic and life saving on a scale that hundreds of thousands of people might need immediately? Who would be given them if there wasn't enough for everyone?

Would you give it to the children first? The patient with the greatest chance of survival? The patient who provides the greatest contribution to society? Like the doctors? Nurses? Emergency response personnel? Yourself? Your family?

It is a tough thing to answer. It is also a real-life scenario in much of the world.

Does it happen in vet med? Of course. Every single day. Resources are limited. Access is limited. And not everyone gets the best of veterinary care even if it is available and accessible simply because they need it.

It is a common practice to utilize the skills, practice and lessons of another profession when trying to decide the best course of action in a current dilemma. So, why wouldn't human medicine follow our guidelines and protocols for the same set of scenario's?

The same scenarios apply in both human and veterinary medicine, BUT, the compassion is lacking on one side of the care giving side. Veterinarians provide care to those that pay for it. If it was free and available on the same scale to everyone who needed it we would face the same ethical decisions to deciding who gets what when they need it. But alas we don't. It is far simpler to ration based on economics. Cut and dry.

Should it be this way? I am not sure? I think that the reason we on the veterinary side don't provide everything we can to everyone who needs it being simply based on a case of economics limits our ability to understand more complex scenarios. It skews our reasoning skills, our preparation, our sacrifice for a common good. It reduces humanity to individually centered scenarios and decision making trees. It promulgates and promotes self preservation on an individual level. It is impossible to make life saving decisions in mass casualty scenarios when the individual is the source of the lack of compassion on a larger scale.

So the next time you need help ask not what you have access to, ask what you are willing to sacrifice to provide it. Maybe the abandonment of self is the salvation of all?

Resources and Inspiration;

NY Times article, Aug 21, 2016. Whose Lives Should Be Saved? Researchers Ask The Public.


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Trying to Understand True Compassion? Where do you draw the line?

I read the latest issue of dvm360, as I always do, but I had had to put it down, let my emotions settle and resume reading at least three times. After taking an inordinate amount of time to read, I had to walk away, let my inner frustrations settle, and then decide what I was going to do with the burden of my conscious screaming at me.

So, my answer? Throw it out for the world to share my burden, help me understand my frustrations, and hope that with all things that the discussion will open and awaken our collective sense of responsibility and desire to live in a more peaceful and compassionate world.

The headline that has me unloading on all of you was titled, "Oklahoma OKs bill allowing horse slaughter for human consumption."

I know, take a deep breath, its not so easy as to just want to vomit and protest, "well, I'm not eating horse!"

Oklahoma decided on March 26, 2013 by a vote of 32-14 to allow for slaughter of horses for export to countries like Italy, France and Belgium for human consumption. Sounds pretty appalling, doesn't it? But as recently as 2007 there were two facilities in the U.S. that slaughtered horses, Illinois and Texas. They closed because federal funding was eliminated for them. After they closed horses were transported to Canada and Mexico for processing and then exported.

The atrocity of this whole dilemma? Well, after the government banned or assisted in the shut down of the slaughter houses almost everyone agreed that the state of the horses fate worsened significantly. Without a place to send horses many were left or abandoned to starve to death. So the state of OK put HB 1999 before the Senate. To "allow the humane, regulated processing of horses."

My internal struggle is as follows;
Question 1. Do I think it is better to kill an animal then to let it suffer? Answer, Yes. (Do I think the same for people?, I'm not sure anymore. If it is myself, then yes.)
Question 2. Do I think that the horse has a different place in society than a dog or cat? No.
Question 3. Would I ever ponder killing cats or dogs for consumption, No, Horses?, No. Cows? Pigs? Rabbits? Guinea Pigs? (Did you know that all of these species are eaten in many parts of the world?)

The statistics are a good way to put the argument into perspective.

In 2006, the last full year the horse processing plants were open, 102,260 horses were euthanized for processing in the U.S.

The state of OK sent 160,000 to Mexico for processing.

The Association of American Equine Practitioners (AAEP) though it stresses it is not pro-slaughter, does not support current proposed federal legislation to ban horse slaughter for human consumption. The association regards itself as "pro-welfare" of the horse and believes that without long term placement for affected horses and the placement for affected horses and solutions to the core issues that contribute to the unwanted horse population, humane euthanasia and processing for human consumption may be an undesirable necessity. "If a horse owner is not able or willing to provide humane care, the AAEP believes that euthanasia at a processing facility is a humane alternative to a life of suffering, inadequate care and possibly abandonment."

To thicken the plot, many states - Arkansas, Montana, North Dakota, Nebraska among others - are trying to introduce legislation to promote the opening of plants in their own states because the horse slaughter industry reports in 2006 the industry grossed an estimated $65 million.

Animal welfare advocates dispute many of the claims of horses being treated better when the horse slaughtering plants were open, and feel the reason so many horses are sent to slaughter is because of economic hardships, and that the argument that horses are better of being killed is ridiculous. Wayne Pacelle, the president and chief executive of the Humane Society of the United States stated that "horse owners should commit to providing lifetime care for the animals."

It is my firm opinion that any life that you chose to take responsibility for is a life long choice. How do we have over 3 million dogs and cats euthanized every year in the US? Is it better to bury them? If we can't find homes for our unwanted pets what do we do with them?


For the complete dvm360 May 2013 article please see;
http://goo.gl/OByVU

For the New York Times article from October 11, 2011, please see;
http://tinyurl.com/cb2wuy7