The human story of how ventilators came to breathe for us
Polio patient in an iron lung at the Scots Mission Hospital in Tiberias, Palestine in March 1940. When polio weakened muscles used in breathing, an iron lung assisted respiration

Robert Truog, who directs the Harvard Medical School Center for Bioethics, co-wrote the Massachusetts guidelines on rationing ventilators in April 2020. He and his colleagues considered giving the families of patients removed from ventilators the option to hand-ventilate their sick family member, as students had done with Blegdam’s patients nearly 70 years before. The ethicists decided not to offer families that option, says Truog, citing three issues: burdening family members unrealistically; medical complications that would likely result from the efforts of untrained human ‘ventilators’ and, finally, the likelihood that those patients wouldn’t survive anyway. ‘It would be cruel to the family to put them in the position of having to squeeze the bag, when in all likelihood the patient wouldn’t survive,’ he said.

Truog is referring to the concept of medical futility: moments when doctors decide not to offer certain interventions, because those interventions won’t help the patient enough to justify the harms. Futility is the most common ethical dilemma in the modern ICU. The question guiding care becomes not just how to save lives, but when to allow deaths. Not just animating machines, but deciding when to use them, and when not to.

Before physicians understood how people breathed, they couldn’t help people to continue breathing. They tried anyway – and all of their efforts, though well-intended, constituted futile care: interventions not reasonably likely to bring more good than harm. The term ‘futility’ didn’t exist not because the problem didn’t yet exist, but because the problem was too big to see. Scientifically sound ventilation methods changed that.

Now, doctors can prolong life – but not always in a condition that patients would choose to live with. We have to ask: what quality of life would we consider worth living? If the best possible medical care can’t give a patient a reasonable quality of life, patients and their physicians decide to withdraw or discontinue further treatment. We see it on medical shows – characters say: Don’t keep me on a machine. They often mean a ventilator. The more advanced and effective the ventilator has become, the more questions of futility arise.

How much can, or should, the ventilators of the future help doctors make decisions about when to turn off machines? The ‘ventilator’, once a caring human using arm muscles as proxy for patients’ paralysed diaphragms, is now a programmed device – and that programming could some day make decisions of life and death. The machines that have extended life might, in time, help to determine when it ends.

Read more or listen to the audio on Aeon.

This is an external article from our library

Everyone is talking about caregiving, but it can still be difficult to find meaningful information and real stories that go deep. We read (and listen to and watch and look at) the best content about caregiving and bring you a curated selection.

Have a great story about care work? Use our contact form to submit it to us so we can share it with the community!

Related Articles

Popular categories

After Caregiving
Finding Meaning
Finding Support

Don't see what you're looking for? Search the library

Share your thoughts


Share your thoughts and experiences

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Join our communities

Whenever you want to talk, there’s always someone up in one of our Facebook communities.

These private Facebook groups are a space for support and encouragement — or getting it off your chest.

Join our newsletter

Thoughts on care work from Cori, our director, that hit your inbox each Monday morning (more-or-less).

There are no grand solutions, but there are countless little ways to make our lives better.

Share your insights

Caregivers have wisdom and experience to share. Researchers, product developers, and members of the media are eager to understand the nature of care work and make a difference.

We have a group specifically to connect you so we can bring about change.