Comments on: Triage: If You Thought I was Over-reacting with the Food Storage Stuff…

By: Linda Buzzell

Linda Buzzell — Tue, 13 May 2008 15:44:11 +0000

Some of the best analysis of our situation that I’ve ever read, Sharon! Thank you, thank you…

My only quibble is with #5, the “sheer cowardice of us” bit. Human psychology is a little more complicated than that and most of those who write scientifically and rationally about what we’re facing aren’t very psychologically savvy and have resorted to fear and guilt which research has proven to be poor motivators (and cause trauma to boot).

Your readers might want to check out “The Waking Up Syndrome,” an article I co-wrote with Sarah Anne Edwards which analyzes the psychological stages people go through in waking up to and dealing with our predicament. Eco-anxiety, eco-grief etc. all have to be processed so we can get active and respond appropriately to our challenging circumstances, not hide in denial, freeze in panic or succumb to depression or despair.

The link to the article is http://www.hopedance.org/cms/index.php?option=com_content&task=view&id=413&Itemid=32 It also appeared on http://www.carolynbaker.net

I’m really looking forward to reading your books. We too are involved in “subsistence farming” - in our case a small urban backyard permaculture food forest.

Linda Buzzell, M.A., M.F.T.
International Association for Ecotherapy
http://thoughtoffering.blogs.com/ecotherapy

By: dewey

dewey — Thu, 08 May 2008 17:15:54 +0000

MEA is correct that triage deals with who can be saved and at what cost. Except in the extreme and obvious cases, “contribution to society” questions are not ethical. In the midst of crisis, there is simply no way that a medic surrounded by wounded or sick people can make such decisions. The person with mild to moderate Down’s may work at the recycling plant and be beloved by his family and friends, while the guy in the expensive suit may be a drug dealer. The medic would have to rely on proxies like grooming, indicators of social status, and very possibly race, religion, and sexuality, as many will subconsciously place more value on people who are more like themselves; obviously this is to be discouraged. So in a mass-casualty disaster, the derelict with easily treatable injuries will go ahead of the housewife with full-body burns. (However, where transplant lists are concerned, the derelict will be downgraded severely.)

Western medicine is unaffordable for most in the Third World, but it used to be affordable here and I think it could be more affordable again. Doctors have managed to get themselves a protected monopoly and limit their numbers so that members of their “guild” will always be assured a high income, but if too many of us can’t afford to go to the doctor, at some point their incomes will start to drop and, like the builders of McMansions, they’ll have to either reduce their prices or suffer from the lack of business.

By: Sharon

Sharon — Thu, 08 May 2008 15:33:01 +0000

Just for the record, I think middle-aged is at least 37 (says Sharon who will be 36 in three months
;-)).

I agree that it is dangerous to spin all this stuff out too far - and I absolutely agree with Dewey that it is perfectly possible to keep manufacturing insulin. What seems far more likely than “no insulin ever again” is the situation we have among the third world poor - “no insulin unless you are rich enough to pay for it.” That is, we *have got* to stop the absolute price rationing system for basics like food and medicine - we HAVE TO. Because it isn’t really a matter of what there’s energy enough to keep going, but the larger system.

Sharon

By: MEA

MEA — Thu, 08 May 2008 13:16:12 +0000

Actually, I don’t know if the choice would be upto the patient.

However, I do know west African refugees who chose to let a child in the family die rather than an adult on the theory that a family of young children without any adults would end up dead in the long run.

By: Rebecca

Rebecca — Thu, 08 May 2008 13:06:13 +0000

There’s always that possibility MEA, though I think it’s more than likely the result of these thought games. And even if it did happen, how many adults would say no, save me instead of the 12 year old dying next to me? Even if I didn’t make the choice myself, I’d be consumed with guilt for the rest of my life for being one saved in that situation.

By: MEA

MEA — Thu, 08 May 2008 00:02:26 +0000

Rebecca, in susbstance, I agree with you, and I have a tendency to spin a situtaion out to the wildest bounds — which is what I’m doing — not disagreeing with you — but could there be a situtation in which we were saving lots of children, but not enough adults to care for them? I guess part of the question is what to you consider middle aged? I think it’s 35+.

MEA

By: Rebecca

Rebecca — Wed, 07 May 2008 23:43:58 +0000

I too think there has to be a rational way to allocate triage. It will happen, like it or not, so it’s better to have the protocol in place ahead of time. I don’t have any real problems with this proposed protocol -in such a situation, hard choices have to be made. I don’t like it, but that’s the way it is. I also think the triage should go by age and recovery -I’m sorry, but if you’re resources are limited, you should treat a kid before an elderly or middle age person, and so on. At least when both have the same chance at making it.

By: MEA

MEA — Wed, 07 May 2008 22:50:26 +0000

I’d like to see the criteria for treament in an emergency situtation not depend on a person’s ability to contribute to society (no doubt becuase I have one child who probably won’t) but on their ability to make a meaning full recovery given what is available at the time measured against what it would cost in terms of other lives. To use a very simple example, would be better to keep pouring packed cells, then whole blood, then ringers and finally saline (until there was nothing left) into a anotherwise completely healthy, fit young person with lots of skills, etc. but who had a reptured aortic artery in a situtation where you are using all the resources trying to keep her alive until surgery can be performed or to use the liquids one or 3 bags at a time on lot of other people even if as individuals they didn’t meet the usefullness of person 1?

By: Lisa Z

Lisa Z — Wed, 07 May 2008 22:47:33 +0000

Thanks, Dewey, for your reply to my comment. It is reassuring.

I agree with you that we will probably become less greedy, less selfish, and more willing to make sacrifices. America (as well as other countries) has a history of this, and I don’t see why this “crisis” will be much different. Yes, perhaps more long-term, perhaps more dismal, but in the end I think things will/are happening slowly enough that we have time to adapt and this will mean we’ll find ways to cope and help each other out. I already see this happening, as more people pick up gardening and bicycling and other means of coping.

Still, I worry about those “on the edge”, who have chronic diseases or are already poor, etc. I hope you’re right that some medicines will remain available long-term. I know at least one “normal”, good kid whose life depends on it.

Lisa in MN

By: dewey

dewey — Wed, 07 May 2008 22:35:26 +0000

I meant to comment to Lisa Z - Under any realistic scenario, we would have the tech to treat relatively uncomplicated diseases for generations. Low energy isn’t no energy; pharmaceuticals are manufactured in Africa now. Society should, and hopefully would, choose to allocate severely limited resources first to essential uses, including reasonable healthcare (probably to be defined by a measure of quality-adjusted life years (QALYs) per cost). There will be no problem keeping an insulin factory running, as some important people need insulin too. But I know that injected insulin requires refrigeration; do the supplies for this boy’s pump? If so, a larger challenge might be ensuring that he or his family has some form of refrigeration, or at least a good icebox, if the time comes when average Americans can’t afford such. A state subsidy would be entirely justifiable on the grounds that what is for you a convenience is for him a necessity. But how many Americans will be willing to pay taxes to keep other people’s fridges running when they themselves can’t afford to keep theirs running? Many Americans who now enjoy many luxuries already object on philosophical grounds, or from simple greed, to their tax dollars being used to provide basic necessities to others. Like many others, I have some hope that when we can no longer afford all the luxuries that corporate media have convinced us we must have, we will become less greedy, less selfish, and more willing to make sacrifices for the needy in our communities. But it is also possible that we will adopt an “every man for himself” approach, as the survivalist crowd envisions.