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Comment by DSMan195276 | Hacker News Reader

DSMan195276

> scale up production while making the devices smaller and cheaper, and in the meantime seek out alternative long-term facilities for palliative care to avoid occupying hospital beds.

I feel like you're just hand-waving away the issue. If they could move them out of the ICU they would have, the issue is they require constant care while on the ECMO machine.

Additionally, while the "smaller, cheaper, no care required" devices may appear in the future (the article talks about this very thing), they're not here _right now_. There's currently a limited number of machines and people who can maintain them in the hospital, and hence an immediate problem that they have to deal with when there's more people who can benefit from them than machines they have.

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I'm not hand-waving the issue; as I said, it's clearly a very difficult problem. But it is not an ethical dilemma; it is a resource-allocation problem. In the United States, we are historically good at solving those, when properly motivated.

Why can't more machines be made? Why are there a limited number of people who can maintain them and perform care on a long-term basis? These are questions that lie downstream of many long-standing institutional problems with the practice of medicine in the US, and framing them as ethical "maybe-some-people-should-just-die" questions is missing the broader story.

> But it is not an ethical dilemma; it is a resource-allocation problem.

Sure, it's a resource-allocation problem, but _right now_ it is an ethical dilemma. None of what you're suggesting will suddenly make the problem gone in a year, hence why I called it hand-waving.

> Why are there a limited number of people who can maintain them and perform care on a long-term basis?

You're just asking the question "why aren't there more people working in the ICU?". Somehow I don't think this is a problem that would be solved in a year if someone just 'finally sat down and worked on it'.

As the the article points out, people are _already_ working on the issues you came up with, it just turns out they're actually hard problems to solve.

Well, no, the article doesn't address any of those issues. In the case of the teenager apparently allowed to die through refusal-of-service, the logic of the situation as presented by the hospital—either the child dies, or others die—is not interrogated with regard to possible alternatives. Vastly increasing ICU capacity nation-wide in a single year might be tough (although I don't agree with your framing of its impossibility) but why could it not be done in this particular, local case? It seems obvious that hospitals have a strong incentives to present cost-minimization as "profound ethical dilemmas."

The future work briefly touched on at the end—focusing on organ transplants and miniaturization, and framed by a professional arguing that "the overarching problem here is that we have this fear of letting people die"—does not cover any of the obvious but difficult ways of dealing with individual situations in the near-to-medium term (bottlenecks in production, personnel, etc.).

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