“Withhold Intubation” for certain older Thammasat Hospital patients

Thammasat University Hospital, overwhelmed with Covid-19 infections, has decided to implement a fatal “Withhold Intubation Rule” for patients over 75 years old with severe conditions like incurable cancer and AIDS. The hospital is experiencing an extreme shortage of ventilators and together critical life-saving equipment, and was forced to make the tough decision that will inevitably lead to unnecessary deaths.

The hospital is stressed to capacity and even the overflow field hospital hosts 392 patients, 50 of which are children, plus the 300 patients the hospital is tasked with caring for in-home isolation. Even after sending those 300 patients home in an attempt to free up resources and medical personnel, critical life-saving equipment is still in severely limited supply.

The management released a statement yesterday saying that it would no lover put some severe cases of Covid-19 infections on ventilators to save resources. They will instead focus on palliative care to comfort the patients that cannot be helped fully.

If the patient has created a living will, even if it’s only verbal and not officially written, specifying they do not want intubation and put on a ventilator, the hospital will honour that decision. Family members can also act as decision-making surrogates in choosing not to intubate. Otherwise, medical professionals will consult with the relatives on their course of treatment.

If no advanced directives or living will exists, doctors will evaluate 2 conditions in deciding whether to allot limited ventilators for patients. A spectrum exists called the Clinical Frailty Scale that measures factors like comorbidity, function, and cognition, and the hospital will not proceed with intubation for those who are a level 6 or higher. Level 6 is “Living with Moderate Frailty” someone who requires some assistance to function.

If a patient is over 75 and suffers from AIDS or a metastasised incurable cancer that indicates their lifespan is limited, the hospital will also not administer intubation.

The hospital made this difficult referendum as they struggle to provide care for the growing number of Covid-19 infections while still maintaining normal daily hospital functions and giving care to other patients without Covid-19 that require medical attention.

SOURCE: Thai PBS World