In this new Plague Year, we are being confronted with decisions and actions that rarely impact people in civil society. The hardest burden of fighting this pandemic is falling on every person in the medical community. It is for them we wish today to speak.
In addition to the techniques we all must manage to stay healthy and out of harm's way, our brothers and sisters in the medical community now face, day after day, decisions about who will live, who will die. This is qualitatively different from the norm. In our usual life and death encounters in cities and towns, medical personnel rarely have to triage - make instant choices about who is pretty much OK, who desperately needs medical intervention, and who is too grievously hurt for our medical actions to matter. These are the stuff of rare emergencies such as 9/11. It is the experience of the battlefield and MASH mobile hospital units. It's not the experience of urban or rural practitioners, practitioners on reservations, who are now overwhelmed with patients, many of them desperately ill, but for whom there are far too few treatments.
California Department of Public Health, at the request of hospitals, has created a checklist on standards of care in a world of pain coupled with a shortage of supplies. Chief on the checklist is "longevity expectation" of the person in question. What this means is that older people, those with pre-existing conditions, those with disabilities, and various others will rate lower on the scale of treatment than will others. California Church IMPACT, our sister organization that does advocacy, has protested, along with many allies, the original plan ranking people almost exclusively be age and disability. The protest was entered at 6:00 last night. Some of our concerns were met by 8:30 this morning. But removing life expectancy as a factor was not.
We know these are harsh conditions. We understand that there are often no good decisions. If you have 20 patients needing ventilators but only 15 ventilators, choices will have to be made.
And here is the moral injury. There is not a doctor, nurse, anesthesiologist, respiratory therapist or any other provider who was taught to accept allowing someone to die as an answer to a shortage of supplies right here in America.
We are now asking our medical professionals, the people also risking their own health and safety, to do what they were trained not to do, what society does not want them to do: let people die.
However much we understand the real dilemmas today, when this is over, we are going to have tens of thousands of people who were on the front lines of medical care now suffering from both PTSD and acute moral injury.
It will be up to us in the faith community to help with the latter. We should begin now to learn how to intervene, to help, to nurture and treat those who have served us sl valiantly but who were too often forced into choices no human being, much less a trained medical person, should ever have to make. Helping our fellow congregants, our neighbors and friends, cope with their own suffering will be acts of both trained professionals and of us, compassionate allies. and friends.
There are numerous books on moral injury after war. While this is in some ways worse since it's actions taken on home ground, the findings may be useful to you. One of them, Soul Repair, by Gabriella Lettini and Rita Nakashima Brock, has set a standard for our future understanding and our work. Many others exist and may help guide us in our efforts to help make our medical community whole.
We hope we can begin now, even in the midst of the physical crisis, to prepare for the spiritual and soul-devastating impacts being experienced as part of the solutions.