Sweden was spotlighted earlier during the pandemic for choosing not to enforce lockdowns this spring and instead trusting its citizens to follow public health protocol when in public. Sweden is once again in the news for its approach to care for its elderly who are sick with COVID-19.
Elderly care homes in Sweden have reportedly offered morphine as an alternative to respiratory support to elderly residents ill with COVID-19. This would allow the residents to die without feeling the pain of breathlessness or suffocation. To contrast, in nursing homes in the United States, oxygen is provided as a minimum required standard of care. Through the spring and summer, patients requiring more than advanced respiratory support were put on ventilators if available.
Before writing any further, I should briefly talk about the medical standard of care, which is the care that patients have a right to receive if they seek medical help during an illness.
The medical standard of care depends on where you are treated and by whom. By law, when the standard of care comes into question, it is defined by a medical expert who determines what care should have been provided in a given situation depending on the resources available and health care providers responsible for care. The various standards of care are usually established by guidelines agreed upon in the medical community.
The standards of care will vary from country to country. In the U.S., the American Medical Association has carried weighty influence in standardizing medical care. In Sweden, the National Board of Health and Welfare plays this role in developing the standards of care. The fact that the standard of care is so drastically different between two countries is concerning, to say the least.
Giving the elderly morphine instead of oxygen is unquestionably controversial and has even been called euthanasia by some, including the Patients Rights Action Fund. Part of the concern is that some elderly patients have been denied basic care and have experienced delayed access to intensive care. Delaying access to intensive care in a hospital may be an effort to keep the health care system from being overwhelmed, though reports are vague on that particular point.
Whether or not these reports are true, the reality that too many are suffering early deaths due to COVID-19 is sobering. Reports such as these about Sweden should prompt us to ask several questions, not least of which being how we treat the vulnerable, who in this case are the elderly. If the value of an individual lies in their contribution to society and economy, their value will decline as age, disability and illness take their toll. If worry that the burden of COVID-19 will overwhelm hospitals drives some health care providers to administer morphine, what has the value of a human life been reduced to?
These reports, though often sensationalized, seem to suggest that the value of life is occasionally reduced to an economic bit, materialized as expense to the established socioeconomic system. Economists talk about something like this called the value of a statistical life (VSL). The VSL essentially describes the willingness to pay to reduce various risks of high mortality; however, the actual value of a human life eludes a definition suitable for economics.
Treatment policies—the standards of care—that prescribe morphine instead of oxygen for residents of care homes should be condemned. Understandably, health systems have been strained, and in some cases, beyond capacity during this coronavirus pandemic. Yet reports like those from Sweden that allude to unacceptable treatment of the vulnerable must be investigated, because mistreatment of the vulnerable concerns us as believers in a broken world. Psalm 82 tells us to "maintain the rights of the poor and oppressed," which for voters, policymakers, culture-makers and economic agents means identifying injustices and inequities that involve human life and taking specific action to upend them.