A final word on pushing and shoving

The topic of secondary triage criteria and their applicability in a pandemic has aroused a great deal of debate in many different venues. At the Queensway-Carleton Hospital (QCH)in Ottawa we decided to try to take a formal look at the issue. We arranged a debate -- in standard debate format, on the resolution: "Be it resolved that the QCH adopt societal criteria for the allocation of scarce medical resources in the event of a catastrophic pandemic”. The resolution was deliberately vague on what those "societal" criteria might be in order to generate as open a discussion as possible. The debate was impassioned, and the questions from the audience interested and interesting -- but it is the result of the voting that is most noteworthy. The votes split 21 to 19 against the resolution, which I would say, is about as close to a tie as you can get. Our approach was unscientific, and of course the results were swayed by the approaches of the debaters,but that close a result, I think, means two things. First, we are split on this topic. There is not agreement that we unequivocably should -- or should not introduce non-medical, or "societal" criteria into triage decision-making. And second -- if we don't have a clear agreement to change what we currently do -- we should be cautious about taking a path that leads away from our currently espoused and practiced values.