A Michigan health system has acknowledged it's preparing for hard life-and-death decisions after a hospital letter was circulated online detailing who would be able to receive life-saving resources during the coronavirus pandemic if there's not enough equipment.
A spokesman for the Henry Ford Health System told CNN the "letter is part of a larger policy document developed for an absolute worst-case scenario."
"It is not an active policy within Henry Ford, but it is part of our emergency response planning," the spokesman said.
The letter has not been shared with patients, but aims to explain that the coronavirus pandemic has made some medical supplies hard to find.
"Because of shortages, we will need to be careful with resources," reads the letter, which is addressed to patients, families and the community. "Patients who have the best chance of getting better are our first priority."
"Patients who are treated with a ventilator or ICU care may have these treatments stopped," it says, "if they do not improve over time."
The letter goes on to say patients with severe heart, lung, kidney or liver failure, severe trauma or burns, or terminal cancers may be ineligible for a ventilator or ICU care. These patients will instead receive "pain control and comfort measures."
"This decision will be based on medical condition and likelihood of getting better," the letter says.
'What they put out is honest,' mayor says
The letter is not just indicative of the situation in one Michigan health system, but illustrates the widespread challenges hospital systems across the country have described to CNN about dwindling resources as they struggle to care for patients during the pandemic.
In an email to CNN, Henry Ford Health System said none of its hospitals have reached capacity with Covid-19 patients and the hospitals have not reached their limits on ventilators. The health system had 373 coronavirus patients hospitalized in its facilities as of Friday morning, according to its website.
According to Dr. Adnan Munkarah, the health system's executive vice-president and chief clinical officer, all health systems must be prepared for the worst case scenario.
Henry Ford Health System "carefully crafted our policy to provide critical guidance to healthcare workers for making difficult patient care decisions during an unprecedented emergency. These guidelines are deeply patient focused, intended to be honoring to patients and families," Munkarah said in a statement.
"It is our hope we never have to apply them and we will always do everything we can to care for our patients, utilizing every resource we have to make that happen."
Asked about the letter by CNN's Jim Sciutto, Detroit Mayor Mike Duggan said other major hospital systems dealing with large coronavirus outbreaks are having the same conversations internally.
"Henry Ford is one of America's great healthcare systems," Duggan said. "And what they put out is honest."
"You would be irresponsible as a healthcare system CEO," the mayor added, "if you weren't preparing for that eventuality."
'We are now all together on the Titanic'
Arthur Caplan, director of the Division of Medical Ethics at the NYU Grossman School of Medicine, said he agrees it would be irresponsible for hospitals to be unprepared for the possibility of rationing.
"It's good to be public, it's good to be transparent, it's good to be frank," Caplan said of the Henry Ford letter. Other hospital systems around the country are formulating similar policies, he added, if they don't already have them in place.
Caplan is not surprised if people are upset, he said, but it's inappropriate to simply say, "Rationing is wrong and you can't do it."
"That ignores reality," he said, adding, "If there are 10 people and 3 ventilators, a decision is going to get made."
Hospitals will aim to "maximize the likelihood you can save lives by giving access to the resource," he said. They'll also weigh factors like a patient's health condition and age.
Caplan added that rationing within the healthcare system is nothing new, pointing to insurance and organ transplants.
"The revelation that rationing occurs in the healthcare system is shocking only because most people never faced it," Caplan said. "If you didn't have insurance, if you were homeless, you were rationed. It always has been sadly true, it just doesn't get anybody's attention."
The public, Caplan said, will have to accept that this "is a reality."
"We are now all together on the Titanic," he said. "And it's pretty clear that there aren't enough lifeboats and there aren't enough life preservers."