Who Gets Lifesaving Care? Tennessee Changes Rules After Federal Complaint

The new plan allocates medical care based on how likely patients are to survive their immediate illness if they receive treatment. The previous plan considered their long-term survival prospects as well. That provision was removed because it could disproportionately penalize those who are older or have disabilities.

Some critics argued that factoring in who might live the longest could also disadvantage members of racial minority groups that have higher rates of underlying health conditions. Many of the same groups — particularly African-Americans, Native Americans and Hispanics — have seen a higher incidence of illness and death from Covid-19.

The new guidance contains other changes. When patients have underlying speech and movement disorders, doctors may need to modify their survival scoring system because its assessment of brain injury could be inaccurate. And the new rules state that if age or disability may require longer treatment or more resources, patients should not be made a lower priority because of that.

Both versions of the guidelines provide for removing ventilators — with or without consent — from patients if they are not improving after a certain period so the machines can go to others. Those who rely on personal ventilators to survive in their normal lives are exempted under the new plan. “No person with disabilities on a ventilator should ever be afraid of going to a hospital because it might be taken away from them,” Mr. Severino said.

Tennessee’s plan also no longer categorically excludes certain patients from receiving hospital care, including those with conditions such as multiple sclerosis, amyotrophic lateral sclerosis and spinal muscular atrophy who require ventilators or assistance with common activities. One of the people who brought the complaint against the state has A.L.S.