Should Youth Come First in Coronavirus Care?

In March, the Office of Civil Rights reaffirmed that the Affordable Care Act and other federal statutes prohibit discrimination, in health facilities receiving federal funds, on the basis of age, disability and other characteristics.

Nevertheless, the coalition has argued that guidelines in Oregon, Arizona and northern Texas remain discriminatory. For example, Arizona, which activated its crisis guidelines in June, includes long-term mortality as a consideration, along with the ability to experience “life stages.” While those cases are pending, other civil rights complaints have brought changes in Tennessee, Pennsylvania and Alabama.

None of these efforts, however, prevent individuals like Dr. Churchill from voluntarily declining treatment to benefit the young, or for any other reason. Specifying one’s choices, using an advance directive, is of greater importance than ever during a pandemic.

For those who want to yield their place in the health care line, an organization called Save Other Souls has developed a document that takes effect during a declared state of emergency for Covid-19. Vetted by lawyers, it allows people of any age to cede medical equipment, drugs or hospital care to others. The directive lapses when the emergency ends, or after 18 months.

“It’s akin to the person who runs into a burning building or gives up the last seat on the lifeboat,” said Dr. Andrea Kittrell, an otolaryngologist in Lynchburg, Va., who created the organization in March. “There are those people who are selfless and generous and value other people’s lives as much or more than their own.”

Winnona Merritt, for example, works daily in her vegetable garden in High Point, N.C., sharing cucumbers and squash with her neighbors. Vigorous at 82, Ms. Merritt said she would welcome more good years. But in a pandemic, “I’m afraid I could go to the head of the line, ahead of someone younger, with a family,” she said. “I don’t need that. I’ve had a wonderful life.” With her family’s support, she signed an S.O.S. directive.

Research suggests that altruism and generosity increase at older ages. For example, in recruiting volunteers for Experience Corps, which trains seniors to assist in public schools, the most effective recruiting messages appealed to a person’s desire to help the next generation.

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