[mezentius]

I fail to see how this is, as one specialist puts it, a “profound ethical dilemma," and not simply a temporary and embarrassing misalignment of resources. If you can prevent people from dying—and enable them to live meaningful, sentient lives despite being tethered to a device—then the solution is clear: 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.

The fact that the article frames the problem as "we have this fear of letting people die"—instead of a difficult but solvable problem of research, economy, logistics—seems to me emblematic of a certain dead-end, anti-growth mindset that pervades much of supposedly humanistic writing from the NYer.

So what if this is "a bridge to nowhere?" So is life! And in the end, we are all, in our own ways, waiting for time to run out, tethered to something immovable.

[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.

[mezentius]

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.

[DSMan195276]

> 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.

[mezentius]

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.).

[feoren]

It absolutely boggles my mind that this is such a controversial viewpoint. We're talking about a machine that can keep people not just alive, but awake, talking, and riding an exercise bike, without working lungs or a heart. It's an insane, miraculous treatment, and extremely strong evidence that death is something we can conquer. And people come along and just downvote comments like yours, with no explanation at all, because it's so deeply engrained in their brains they they and everyone they love simply must die, and everyone who believes otherwise must be naive and stupid. Because death is this magical, spiritual, special problem unlike any other problem humanity has ever faced: the one thing we will never be able to solve?

It absolutely is a dead-end, anti-growth mindset, and I don't understand it. Why is everyone so in love with death?

[jprival]

It’s not a particularly fair accounting of the framing of the article, which also profiles people who are working precisely on making the technology more practical and portable and ends on a hopeful note. For the time being it’s a high maintenance way to keep people alive, though, so the ethical dilemmas of resource allocation are real.

[sooheon]

This framing is a false dilemma. All resource allocation decisions are also ethical choices.

[mezentius]

No—not necessarily. In the case of, say, a hypothetical plane crash in a desert, with two thirsty survivors and one cup of water, resource allocation may also be a profound ethical dilemma. The article’s author (and hospital administrators) encourage us to see the situation in this light.

But in our vastly wealthy, highly-productive 21st-century society, this situation need not be not zero-sum; production can be scaled up on demand, priorities can be shifted, costs can be absorbed. What’s constrained in this case is not supply of the life-saving resource, but political and economic will over inertia.

In this case, calling this an “ethical dilemma” stretches both the definitions of “ethics” and “dilemma” to the breaking point. There is a clear right answer here—but the insistence on choosing the wrong answer over and over, to keep costs down and avoid long-delayed reforms to medical staffing and supply chains, leads to tragic outcomes in which a patient’s survival is determined by institutional bureaucracy. That would be a much more useful framing!

[sooheon]

Last I checked we are not post scarcity, so we still are those thirsty survivors vying over limited resources. There is only a clear "right" answer provided we first agree on ethics.

Whether you propose an industry subsidy, or campaign for regulatory reform, or initiate a cabal of technocrats to accelerate progress, every dollar towards this cause is a dollar not spent elsewhere. Strongly asserting that you have the one right answer doesn't make opportunity costs disappear.