http://www.msnbc.msn.com/id/24454529/
Now, THIS is concerning. On the rational level, I have to agree with rationing resources and time, but on the other... Are those with severe mental illness less entitled to life than the rest of us? And how will the severity of the mental illness be defined in that case? Do our parents have less of a right to survival? If the disaster strikes, it will be a time for difficult choices - and some of the choices now have the official endorsement from the government.
First off, I must point out the wonderful Freudian Slip:
Do our parents have less of a right to survival?
Now that that's out of the way......
I've been an alternate-reality, cold-war nuclear era disaster buff since I was a kid. I have a big collection of civil defense booklets and guides outlining how stuff like this should go down, and I've often thought about how this scenario would bear out.
It's not a scene anyone wants to even think about, but it's necessary and important. Everyone was outraged when after Katrina forced us to think about doctors making these decisions. But again, it's part of our world.
One could go extreme and think about the worst case scenario, affectionately termed (WCS0 in the old pamphlets where even re-population is a consideration. In a more common scenario, the old "women and children first" cliche comes from somewhere, and in essence, it's correct.
Attempting to save the severely demented or badly burned is considered a waste and lessens the chances of survival of those with more meaningful life ahead of them by brain draining and using valuable resources. This of course makes sense. Complexities arise, however, when a survival group knows that a particular type of patient is typecast into a death sentence should they contract a particular disease or affliction. i.e. morale and such.
In terms of "our patients," I think it's good to fight for our so-called population of patients. However, psychiatry is by no means unique in this regard. Those with COPD who are unable to walk, travel or would otherwise hold up the group may not be a priority to save, nor would someone who's likely to die from infection without heroic measures.
How will severity of mental illness be defined? Again, there's no easy answer. There is likely to be a non-published checklist of basic human funcitons that are expected of a member of a survival group. If you don't make that cutoff, then you'll not be maintained.
