This story is making the rounds, and I have some thoughts I haven't seen expressed elsewhere yet. Most seem focused on questions of legal over-reach and congratulatory remarks for the HCWs who "stood their ground" in refusing to administer ivermectin. https://www.chicagotribune.com/coronavirus/ct-elmhurst-hospital-ivermectin-covid-court-order-20210504-2dvay7tatzartk2ijv23hgdxw4-story.html 1/

I love critical care medicine, but it is not a field known for its strong evidence base; there are treatments for COVID (among other diseases) being administered in ICUs right now based on as little evidence as exists for ivermectin, sometimes despite evidence of harm. 2/

Ivermectin is highly-politicized as a proposed COVID therapeutic, which I think is driving the tenor of the reactions I've seen. I wonder how this story would have played out if the patient's family had demanded something like empiric anticoagulation or convalescent plasma. 3/

I have no doubt there is an ICU in the US using ivermectin for COVID. Could this patient have been transferred there? If logistic factors like financial constraints prevented it, is that a good reason the patient's decision-making about their plan of care should be abridged? 4/

Finally, I wonder about the relationships among the care team and this patient's family that led this disagreement to be resolved in the legal setting. If there's one lesson I learned from clinical mediation training @PennMEHP, it's this: 5/

Your decision can be airtight and "correct" according to a rigorous ethical analysis, but if it leaves stakeholders feeling irreparably harmed or betrayed, as I imagine this family might have, you have failed. Which is sometimes unavoidable, but a failure nonetheless. 6/6