See the document here: http://www.siaarti.it/SiteAssets/News/COVID19%20-%20documenti%20SIAARTI/SIAARTI%20-%20Covid19%20-%20Raccomandazioni%20di%20etica%20clinica.pdf . English equivalent can easily be found online.
In normal circumstances this sort of triage involves a small number of patients per year, so small as to be statistically irrelevant. With the COVID-19 crisis, we are talking about mass triage. Hence, not really an ethical but a political-ideological choice, cold-bloodedly planned.
I have always been a fervent opponent of any kind of euthanasia, whatever the name given to it. Developing a demagogical narrative about « personal choice » to « dying with dignity » while privatizing health-care is an exclusivist crime, there is no other name for it. Effective individual choice only exists when it is not adversely over-determined by missing essential material conditions.
I believe that current so-called Ethics Committees in the West are unworthy of their function and in some case of their Hippocratic oath. I am not a doctor in medicine but like J. Testart, I know enough about the societal and classes influence on the working of institutions to firmly believe that normal citizens must have their say in such Committees.
It was not easy for me to reach my viewpoints ( especially as a scientifically-trained – Marxist – theoretician.) The main hurdle for me was to deal with the unacceptability of suicide. In my view suicide, and especially assisted-suicide, is a complete individual and collective defeat. But then I believe that, in his own way, the ethical modern pioneer theoretician, Immanuel Kant, was right in distinguishing Pure and Practical Reason.
Not that I believe for a moment that compromising compromises are ever acceptable. But, in the end, freedom and the right to dispose of one’s own self must be preserved. But that should be done within the most rigorous protocols. If for no other reasons than the fact that signatories of so-called biological testaments in countries that have legalised forms of euthanasia, are known to come back on their decision at the last moment … if given the opportunity. Freeing hospital beds for profit reason is in my view a grievous crime and I am quite ready to extend this to the use of morphine and the likes when used, as is often the case, in exponential amounts. Everyone knows that this fatally and quickly leads to death by pulmonary complications. Here too the patient’s clearly expressed will should be scrupulously respected. But at the same time, as the precautionary principle should imply, society should deploy all means to develop and use the pain killers that do not have these known adverse effects. This is not done and is not even the object of research. The matter is largely pushed aside. Although the writing of the destruction of public social services, especially public health-care, was written on the wall, a degenerated liberist Left swallowed it all. (1) The current parasitic dominant class prefers to spend money to feed a new arms race, including militarization of space and bioweapons instead of focusing on social priorities and needs. Cuba, China, Vietnam and few other countries are exceptions. Our own societies – Welfare State and Etat Social – equally favored social needs and a « just society » agenda a few decades ago, that is before the launching of the neoliberal monetarist counter-revolution by Volcker-Reagan-Thatcher in 1979-1982. (2)
In the current context, with the Covid-19 crisis, which follows a highly exponential path if not rapidly contrasted, intensive care units are rapidly saturated. There is not enough free hospital beds, let alone in intensive care, to cope. Waves of patients need reanimation and the absence of know and rapid cures as well as the long stay required by patients when admitted in the intensive care units, do complicate things. Furthermore, when confinement is not declared in the very early phases, the peak is reached much later and the downward curve takes a much longer time to materialise. Asymptomatic individuals can contaminate others.
Today Western philo-Semite Nietzschean (3 ) Ethics Committees quickly explain that triage is a matter of democracy and of social redistributive justice. First, in the current case, triage means that confirmed cases of Covid-19 are sent home with the advise to quarantine themselves. Secondly, it also means that someone following current guidelines will decide who to save or not with longer stays in the intensive care units. Only public indignation pushes authorities – usually after long delays – to provide more needed equipments and more intensive care units. Or miserably lacking masks and gels etc. (4)
The expression « social redistributive justice » should trigger in your mind memories of the plain ineptitudes proffered by Rawls and Giddens and the likes. Giddens eventually retracted part of them. Not the current Ethics Committees.
Like social justice, the argument is spurious because it pretends to proceed with the implementation of a simple and neutral redistribution of resources, that is resources left to redistribute given the prevailing income and wealth structures. It does this without mentioning who produces these redistributed resources – or surplus value. Aside from the workers, current unregulated banks and transnational enterprises only produce speculation, debt and the destruction of the environment. As usual the workers are left to pay for the damages caused by their « animal spirits »
The model unfolds just like R. Dahl’s municipal democracy where everyone is supposed to be equal to any other. Even in the United States!!! This is not how our society is organised. 1 % is super rich. The rest works to scrap out some sort of living in the most unsecure neoliberal monetarist and speculative context. Most are likely to be broke if the wild-swings of the Stock Exchange happen to be greater than usual. And it is not true that in such context what one looses another one gains: many owners of 401 K were left with 201 K at best, and over 40 year-old this means that you cannot recouped your losses unless you win at the lottery. (5)
Aside from poorly funded Medicare and Medicaid, some have Health-care insurance, some tragically do not and most do not have one that covers most foreseeable needs. Even in Western countries where public health-care systems have managed to survive alongside private ones, the linear cuts have been so profound that they are not prepared to face a crisis.(6) Even if you have coverage, the undescribebile degradation of health-care accessible to the masses is so degraded that triage is imposed pitilessly. And waiting lists are made to hover around 10 to 12 hours to discourage patients to go to emergency wards!!! (7)
We are not blaming the doctors. They are placed in a « fait accompli » situation and must act as in exceptional war-like conditions. They are trying to do their best. But they are doing so in the most unnatural and most unacceptable fashion, one against which the best of them have been protesting for years. In such conditions, not only they cannot really practice their science with dignity, but the will of their patients cannot be respected simply because the patients have previously disappeared as Human beings. They are instead treated like hospital beds to be freed as soon as possible. It is a business-like management geared to optimize profits, but at a time when the CFO is dictating to the CEO. It has and cannot have anything to do with health-care.
In such conditions what does one need to think about the long delay wasted in facing the Covid-19 crisis – not to speak of the cynical and demented epigones who openly speak of « herd immunity » when the spreading that this would imply would fatally lead to more aggressive mutations? Today it has already been said that there are two strains of coronavirus, a S and a L strain, and the latest L strain displays the virulence now experienced in Italy and, with some delay, in France and elsewhere. (8) As for the UK, there better be a peaceful citizens’ revolution quickly before millions will be exposed and die. Just do the arithmetic using the dying rate in Italy which is now more than double the Chinese rate at its peak. Of course, later we will have to verify these numbers to make such that all Covid-19 victims were declared as such, and not abstracted from the list with the pretext that some of them were suffering from other illnesses before they died …
The real issue is that the Minimal Sate enforced by neoliberal monetarist public policy is not only crass demagogy, it is not only part of a crass economic narrative (9) but it clearly is a class and cast war waged against born citizens by self-elected groups that pretend « once again » to « return society to a state of new domesticity and new slavery ».
They have almost won. But the present Covid-19 crisis as pitilessly unmasked them more than the rise of gasoline prices did for the Gilets jaunes. (10)
For Humanity to survive and prosper they must be washed away. The sooner, the better.
Paul De Marco, former professor of International Relations – International Political Economy.
Notes:
1 ) See the pertinent essays here, especially those on Schiavo http://www.la-commune-paraclet.com/fascismFrame1Source1.htm#racisme
2 ) See « The socio-economic consequences of Volker, Reagan and Co » march 1985 in the file « Another America is possibly » in http://rivincitasociale.altervista.org/another-america-possible-feb-1-2017/ The file and the Category of the same name in the site provide the necessary updating. See also the International Political Economy section of my old Jurassic site www.la-commune-paraclet.com especially the essays « Credit without collateral » and « The Treasury and the FED » dealing with the 2007-2008 crisis.
3 ) For this delirious philo-Semite Nietzschean aspect you should check L Mises’s work in particular his book entitled Socialism https://mises.org/library/socialism-economic-and-sociological-analysis . The fascist Austrian-Jew L. Mises affirms that it is the public health-care system that CREATES illness which otherwise would only be a holistic psychological matter of Will. This is said after pages after pages of apologies for eugenics. (see pp 475-476 ecc.) In effect, with a life-expectancy of around 40 years the half-billion Dalits comrades in India cannot afford the luxury to be sick. Today citizens are once again treated like Chandalas, rubbles, herds etc … In the West, the rabbinical-Nietzschean disciples of L. Mises do their best to abolish sickness abolishing public health-care, after ensuring their own access to select private care !!! For the crackpot L Mises any type of State interventionism is to be pathologically considered a form of « socialism ». Including the highly successful – capitalist – German war planning during the First WW, aside from the Keynesianism and economic regulation theories that successfully flourished in the aftermath of the Second WW.
On this philo-Semite Nietzschean a-democratic and exclusivist pathology see « Nietzsche as an awakened nightmare » as well as « Heidegger and the intimate corruption of the soul and of Human becoming. » in the Livres-Books section of my old Jurassic site www.la-commune-paraclet.com
What do I mean by « philo-Semite Nietzscheism» ? It is briefly explained here: http://rivincitasociale.altervista.org/dovere-di-memoria-cosa-intendo-con-il-termine-filosemita-nietzschiano/
4 ) See the instructive and frank interview with Pr. Juvin in « interview politique du Pr. Philippe Juvin, chef des urgences de l’hôpital Pompidou de Paris » https://www.youtube.com/watch?v=HQ79j9stg5o
5 ) see The Covid-19 Dominoes Fall: The World Is Insolvent by Tyler Durden Mon, 03/16/2020 – 14:00 Authored by Charles Hugh Smith via OfTwoMinds blog, https://www.zerohedge.com/markets/covid-19-dominoes-fall-world-insolvent )
6 ) The Italian health-care system suffered more than 37 billion euros cuts since 2011 which means that some 36 000 nurses as well as some 8000 doctors would be needed to make the system functional – worse still many are retiring without any replacement while the numerus clausus is still imposed in medicine faculties. It is said that to be comparable to the average EU statistics 1 million 435 thousands medical personnel are lacking… Today even the richest regions in the countries are pitifully unable to cope with the present emergency. The failed so-called «Model of the Nord-East» as well as rampant corruption go a long way to explain the current predicament, see for instance Fromigoni and the xenophobic and incompetent Lega leaders. See « Come l’austerità ha distrutto la sanità », di Coniare Rivolta* https://contropiano.org/news/news-economia/2020/03/17/come-lausterita-ha-distrutto-la-sanita-0125360 See also my essay here : http://rivincitasociale.altervista.org/la-sanita-tra-tagli-e-corruzione-una-vittima-eccellente-del-federalismo-fiscale/
7 ) Year ago European countries, proud of their public health-care systems, used to laugh gently about the private American system – see Peter Sellers’s hilarious performance in « Where does it hurt» (1972) It is more than two decades now that they are emulating the badly flawed and inhuman commercial American system … Go figure!!!
8 ) COVID-19 Mutation and Evolution https://www.youtube.com/watch?v=FYPZHA-UjUY&t=23s
9 ) See the summary of the critique in « The pseudo-economic science of the bourgeoisie : here is why we should quickly change economic paradigm » in http://rivincitasociale.altervista.org/the-pseudo-economic-science-of-the-bourgeoisie-here-is-why-we-should-quickly-change-economic-paradigm/ . See also this essay http://rivincitasociale.altervista.org/covid-19-without-public-credit-and-without-state-owned-companies-neoliberal-management-of-the-current-crisis-will-be-more-disastrous-than-that-of-2007-2008-from-which-we-never-recovered-march-13/
10 ) http://rivincitasociale.altervista.org/purchasing-power-standard-of-life-socially-necessary-working-time-and-global-net-income-of-the-households-2-31-dec-2018/
DISGUSTED RAPID COMMENT ON TRIAGE AS UNSPOKEN EUTHANASIA OF THE WEAKEST AND POOREST, March 17 2020.
Posted: 17th Marzo 2020 by rivincitasociale in Another America is possible, Commenti rapidi, SARS-Cov-2See the document here: http://www.siaarti.it/SiteAssets/News/COVID19%20-%20documenti%20SIAARTI/SIAARTI%20-%20Covid19%20-%20Raccomandazioni%20di%20etica%20clinica.pdf . English equivalent can easily be found online.
In normal circumstances this sort of triage involves a small number of patients per year, so small as to be statistically irrelevant. With the COVID-19 crisis, we are talking about mass triage. Hence, not really an ethical but a political-ideological choice, cold-bloodedly planned.
I have always been a fervent opponent of any kind of euthanasia, whatever the name given to it. Developing a demagogical narrative about « personal choice » to « dying with dignity » while privatizing health-care is an exclusivist crime, there is no other name for it. Effective individual choice only exists when it is not adversely over-determined by missing essential material conditions.
I believe that current so-called Ethics Committees in the West are unworthy of their function and in some case of their Hippocratic oath. I am not a doctor in medicine but like J. Testart, I know enough about the societal and classes influence on the working of institutions to firmly believe that normal citizens must have their say in such Committees.
It was not easy for me to reach my viewpoints ( especially as a scientifically-trained – Marxist – theoretician.) The main hurdle for me was to deal with the unacceptability of suicide. In my view suicide, and especially assisted-suicide, is a complete individual and collective defeat. But then I believe that, in his own way, the ethical modern pioneer theoretician, Immanuel Kant, was right in distinguishing Pure and Practical Reason.
Not that I believe for a moment that compromising compromises are ever acceptable. But, in the end, freedom and the right to dispose of one’s own self must be preserved. But that should be done within the most rigorous protocols. If for no other reasons than the fact that signatories of so-called biological testaments in countries that have legalised forms of euthanasia, are known to come back on their decision at the last moment … if given the opportunity. Freeing hospital beds for profit reason is in my view a grievous crime and I am quite ready to extend this to the use of morphine and the likes when used, as is often the case, in exponential amounts. Everyone knows that this fatally and quickly leads to death by pulmonary complications. Here too the patient’s clearly expressed will should be scrupulously respected. But at the same time, as the precautionary principle should imply, society should deploy all means to develop and use the pain killers that do not have these known adverse effects. This is not done and is not even the object of research. The matter is largely pushed aside. Although the writing of the destruction of public social services, especially public health-care, was written on the wall, a degenerated liberist Left swallowed it all. (1) The current parasitic dominant class prefers to spend money to feed a new arms race, including militarization of space and bioweapons instead of focusing on social priorities and needs. Cuba, China, Vietnam and few other countries are exceptions. Our own societies – Welfare State and Etat Social – equally favored social needs and a « just society » agenda a few decades ago, that is before the launching of the neoliberal monetarist counter-revolution by Volcker-Reagan-Thatcher in 1979-1982. (2)
In the current context, with the Covid-19 crisis, which follows a highly exponential path if not rapidly contrasted, intensive care units are rapidly saturated. There is not enough free hospital beds, let alone in intensive care, to cope. Waves of patients need reanimation and the absence of know and rapid cures as well as the long stay required by patients when admitted in the intensive care units, do complicate things. Furthermore, when confinement is not declared in the very early phases, the peak is reached much later and the downward curve takes a much longer time to materialise. Asymptomatic individuals can contaminate others.
Today Western philo-Semite Nietzschean (3 ) Ethics Committees quickly explain that triage is a matter of democracy and of social redistributive justice. First, in the current case, triage means that confirmed cases of Covid-19 are sent home with the advise to quarantine themselves. Secondly, it also means that someone following current guidelines will decide who to save or not with longer stays in the intensive care units. Only public indignation pushes authorities – usually after long delays – to provide more needed equipments and more intensive care units. Or miserably lacking masks and gels etc. (4)
The expression « social redistributive justice » should trigger in your mind memories of the plain ineptitudes proffered by Rawls and Giddens and the likes. Giddens eventually retracted part of them. Not the current Ethics Committees.
Like social justice, the argument is spurious because it pretends to proceed with the implementation of a simple and neutral redistribution of resources, that is resources left to redistribute given the prevailing income and wealth structures. It does this without mentioning who produces these redistributed resources – or surplus value. Aside from the workers, current unregulated banks and transnational enterprises only produce speculation, debt and the destruction of the environment. As usual the workers are left to pay for the damages caused by their « animal spirits »
The model unfolds just like R. Dahl’s municipal democracy where everyone is supposed to be equal to any other. Even in the United States!!! This is not how our society is organised. 1 % is super rich. The rest works to scrap out some sort of living in the most unsecure neoliberal monetarist and speculative context. Most are likely to be broke if the wild-swings of the Stock Exchange happen to be greater than usual. And it is not true that in such context what one looses another one gains: many owners of 401 K were left with 201 K at best, and over 40 year-old this means that you cannot recouped your losses unless you win at the lottery. (5)
Aside from poorly funded Medicare and Medicaid, some have Health-care insurance, some tragically do not and most do not have one that covers most foreseeable needs. Even in Western countries where public health-care systems have managed to survive alongside private ones, the linear cuts have been so profound that they are not prepared to face a crisis.(6) Even if you have coverage, the undescribebile degradation of health-care accessible to the masses is so degraded that triage is imposed pitilessly. And waiting lists are made to hover around 10 to 12 hours to discourage patients to go to emergency wards!!! (7)
We are not blaming the doctors. They are placed in a « fait accompli » situation and must act as in exceptional war-like conditions. They are trying to do their best. But they are doing so in the most unnatural and most unacceptable fashion, one against which the best of them have been protesting for years. In such conditions, not only they cannot really practice their science with dignity, but the will of their patients cannot be respected simply because the patients have previously disappeared as Human beings. They are instead treated like hospital beds to be freed as soon as possible. It is a business-like management geared to optimize profits, but at a time when the CFO is dictating to the CEO. It has and cannot have anything to do with health-care.
In such conditions what does one need to think about the long delay wasted in facing the Covid-19 crisis – not to speak of the cynical and demented epigones who openly speak of « herd immunity » when the spreading that this would imply would fatally lead to more aggressive mutations? Today it has already been said that there are two strains of coronavirus, a S and a L strain, and the latest L strain displays the virulence now experienced in Italy and, with some delay, in France and elsewhere. (8) As for the UK, there better be a peaceful citizens’ revolution quickly before millions will be exposed and die. Just do the arithmetic using the dying rate in Italy which is now more than double the Chinese rate at its peak. Of course, later we will have to verify these numbers to make such that all Covid-19 victims were declared as such, and not abstracted from the list with the pretext that some of them were suffering from other illnesses before they died …
The real issue is that the Minimal Sate enforced by neoliberal monetarist public policy is not only crass demagogy, it is not only part of a crass economic narrative (9) but it clearly is a class and cast war waged against born citizens by self-elected groups that pretend « once again » to « return society to a state of new domesticity and new slavery ».
They have almost won. But the present Covid-19 crisis as pitilessly unmasked them more than the rise of gasoline prices did for the Gilets jaunes. (10)
For Humanity to survive and prosper they must be washed away. The sooner, the better.
Paul De Marco, former professor of International Relations – International Political Economy.
Notes:
1 ) See the pertinent essays here, especially those on Schiavo http://www.la-commune-paraclet.com/fascismFrame1Source1.htm#racisme
2 ) See « The socio-economic consequences of Volker, Reagan and Co » march 1985 in the file « Another America is possibly » in http://rivincitasociale.altervista.org/another-america-possible-feb-1-2017/ The file and the Category of the same name in the site provide the necessary updating. See also the International Political Economy section of my old Jurassic site www.la-commune-paraclet.com especially the essays « Credit without collateral » and « The Treasury and the FED » dealing with the 2007-2008 crisis.
3 ) For this delirious philo-Semite Nietzschean aspect you should check L Mises’s work in particular his book entitled Socialism https://mises.org/library/socialism-economic-and-sociological-analysis . The fascist Austrian-Jew L. Mises affirms that it is the public health-care system that CREATES illness which otherwise would only be a holistic psychological matter of Will. This is said after pages after pages of apologies for eugenics. (see pp 475-476 ecc.) In effect, with a life-expectancy of around 40 years the half-billion Dalits comrades in India cannot afford the luxury to be sick. Today citizens are once again treated like Chandalas, rubbles, herds etc … In the West, the rabbinical-Nietzschean disciples of L. Mises do their best to abolish sickness abolishing public health-care, after ensuring their own access to select private care !!! For the crackpot L Mises any type of State interventionism is to be pathologically considered a form of « socialism ». Including the highly successful – capitalist – German war planning during the First WW, aside from the Keynesianism and economic regulation theories that successfully flourished in the aftermath of the Second WW.
On this philo-Semite Nietzschean a-democratic and exclusivist pathology see « Nietzsche as an awakened nightmare » as well as « Heidegger and the intimate corruption of the soul and of Human becoming. » in the Livres-Books section of my old Jurassic site www.la-commune-paraclet.com
What do I mean by « philo-Semite Nietzscheism» ? It is briefly explained here: http://rivincitasociale.altervista.org/dovere-di-memoria-cosa-intendo-con-il-termine-filosemita-nietzschiano/
4 ) See the instructive and frank interview with Pr. Juvin in « interview politique du Pr. Philippe Juvin, chef des urgences de l’hôpital Pompidou de Paris » https://www.youtube.com/watch?v=HQ79j9stg5o
5 ) see The Covid-19 Dominoes Fall: The World Is Insolvent by Tyler Durden Mon, 03/16/2020 – 14:00 Authored by Charles Hugh Smith via OfTwoMinds blog, https://www.zerohedge.com/markets/covid-19-dominoes-fall-world-insolvent )
6 ) The Italian health-care system suffered more than 37 billion euros cuts since 2011 which means that some 36 000 nurses as well as some 8000 doctors would be needed to make the system functional – worse still many are retiring without any replacement while the numerus clausus is still imposed in medicine faculties. It is said that to be comparable to the average EU statistics 1 million 435 thousands medical personnel are lacking… Today even the richest regions in the countries are pitifully unable to cope with the present emergency. The failed so-called «Model of the Nord-East» as well as rampant corruption go a long way to explain the current predicament, see for instance Fromigoni and the xenophobic and incompetent Lega leaders. See « Come l’austerità ha distrutto la sanità », di Coniare Rivolta* https://contropiano.org/news/news-economia/2020/03/17/come-lausterita-ha-distrutto-la-sanita-0125360 See also my essay here : http://rivincitasociale.altervista.org/la-sanita-tra-tagli-e-corruzione-una-vittima-eccellente-del-federalismo-fiscale/
7 ) Year ago European countries, proud of their public health-care systems, used to laugh gently about the private American system – see Peter Sellers’s hilarious performance in « Where does it hurt» (1972) It is more than two decades now that they are emulating the badly flawed and inhuman commercial American system … Go figure!!!
8 ) COVID-19 Mutation and Evolution https://www.youtube.com/watch?v=FYPZHA-UjUY&t=23s
9 ) See the summary of the critique in « The pseudo-economic science of the bourgeoisie : here is why we should quickly change economic paradigm » in http://rivincitasociale.altervista.org/the-pseudo-economic-science-of-the-bourgeoisie-here-is-why-we-should-quickly-change-economic-paradigm/ . See also this essay http://rivincitasociale.altervista.org/covid-19-without-public-credit-and-without-state-owned-companies-neoliberal-management-of-the-current-crisis-will-be-more-disastrous-than-that-of-2007-2008-from-which-we-never-recovered-march-13/
10 ) http://rivincitasociale.altervista.org/purchasing-power-standard-of-life-socially-necessary-working-time-and-global-net-income-of-the-households-2-31-dec-2018/