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Published On May 27, 2020

POLICY

God Panels, Then and Now

Who most deserves a medical device? A brief history of an impossible conversation.

In the summer of 1961, six men and one woman were called to meet in a ground-floor library in Seattle, near Swedish Hospital. Their job was not easy: Review short biographies of various patients and decide which would be given a new life-saving treatment. The panel consisted of a minister, a housewife, a banker and other members of the local community. The seven were officially called the Admissions and Policies Committee of the Seattle Artificial Kidney Center, but soon became known as the “God committee.”

The hand of God, in this case, was dialysis. While a machine for treating acute kidney failure had become available in 1943, it wasn’t until 1960, when Belding Scribner at the University of Washington invented the Teflon shunt, that safe, regular dialysis became possible. It could pull patients back from the brink of death. The Kidney Center eventually had only three machines, though, and treatment was expensive, costing $15,000 a year for each patient.

Physicians identified scores of candidates. Scribner, however, felt that having doctors choose who got the treatment—and who didn’t—would create an impossible ethical bind, requiring them to pretend to be impartial about their own patients. Instead he asked the King County Medical Society to convene a panel of citizens to decide who would receive it.

The committee quickly got to work, and the way its members made their decisions has become a fascinating—and sometimes chilling—crash course in bioethics. Their first decision was that dialysis should go only to Washington taxpayers, because their money had funded the research. That still left them the task of deciding which residents most deserved the chance to live.

A prime factor was how well the patient was likely to do with the treatment. Physicians had warned that patients over the age of 45 were more likely to develop serious medical complications. But the panel’s conversation took this in other directions as well. One member urged that a man’s church work should be considered, because “moral strength” would help him endure the twice-weekly, overnight dialysis sessions.

A recurring theme was the “social worth” of the individual, saving those who had the most to give back. This slowly evolving calculus factored in the applicant’s age, number of dependents, educational background and potential for future contributions to society. The group also became absorbed in whom each patient would leave behind. “For the children’s sake, we’ve got to reckon with the surviving parent’s opportunity to remarry,” said one panelist, a labor leader. “A woman with three children has a better chance to find a new husband than a very young widow with six children.”

The panelists themselves never felt easy about their roles. The sole medical professional among the seven said that “one can just never face these situations without feeling a little sick inside.” The group had also enrolled a pastor, who initially refused before he joined. “I felt I was being asked to do something not within my power ... I told them ‘I do not choose to play God.’”

History knows about their deliberations because reporter Shana Alexander spent six months studying the new technology and observing the committee. Her article, one of the longest LIFE magazine had ever published, talked about the “medical miracle and a moral burden.” The story ignited a national controversy that led to additional articles, documentaries and books—the first national debate on bioethics.

Many were aghast. One issue was that the panel’s math favored those who led conventional lives—married white people with children and steady jobs. As the UCLA Law Review noted in 1968, “the Pacific Northwest is no place for a Henry David Thoreau with bad kidneys.” Scribner was astonished by the publicity and defended the committee as a “fairly reasonable and simple solution to an impossibly difficult problem,” while lamenting that it had taken attention away from the medical breakthrough.

Eventually, dialysis machines became more affordable and widely available. The God committee in Seattle, and a few that had sprung up after it, disbanded. Medicare began to cover the procedure in 1972, and the End Stage Renal Disease Program is now the nation’s longest-standing entitlement program.

But scarcity is a perennial problem in medicine. The environs of Seattle also saw the first U.S. deaths in the COVID-19 pandemic, in which ventilators—devices that can assist breathing—became critically important and in short supply. The question of who most deserved one sparked another national conversation.

In Washington state, those decisions are to be guided by a document on scarce resource management, one of many that were created in the years after 9/11 at the prompting of federal agencies. Most of these guidelines were created with the input of physicians and bioethicists, but some states also sought input from average citizens. Washington was one of these.

In 2010, the state posted ads online and put up flyers in community centers. They asked for volunteers to join an eight-hour discussion on who ought to get scarce resources in the event of a severe influenza pandemic.

The attitudes of the 123 participants—representing a cross-section of races, ages and income groups—held, in large measure, to the precedents of the God committee. They believed that resources should go to patients most likely to survive, and that some—health care workers in particular—were worth saving first. As uncomfortable and imperfect as their conclusions might be, their talks fulfilled the same critical function: that clinicians on the front lines do not have to bear the weight of these terrible decisions alone.

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