Incapacity Teams Say Ontario Authorities Did Not Seek the advice of Them on Life and Demise COVID-19 ‘Triage’ Selections
Ontario Minister of Health Christine Elliott pledged to involve disability attorneys in devising possible “triage protocols” to help determine who might be denied care when hospitals are overwhelmed.
However, key provincial disability stakeholders say they have not been consulted by the ministry on the current drafts. They fear that these drafts will be discriminatory and could be implemented in the short term.
According to The Globe and Mail, hospitals across Toronto were practicing triage protocols to reserve intensive care units (ICU) for those most likely to survive until last week.
Draft triage protocols sent to hospitals on Jan. 13 have not yet been finalized, according to Ontario’s minister of health. However, the drafts’ focus on examining the ability of patients to live “unaided” – in order to consider whether or not care should be allocated – has worried many proponents for people with disabilities.
On April 21, Ontario Minister of Health Christine Elliott told the legislature:
“I have asked for this issue to be addressed – both by people with disabilities and by the Ontario Human Rights Commission. There has been a lot of discussion but nothing has been activated and I can assure you that nothing has been approved at this point. “
AODA alliance lawyer and chairman David Lepofsky says the Jan. 13 draft protocol discriminates against certain disabled people by ranking patients based on their ability to perform instrumental activities of daily living.
“In the case of a person with cancer, an explicit check is made as to whether a person is disabled and can not stand up or can stand up less,” Lepofsky told PressProgress. “If the person is 65 and over with a progressive disease, they will be asked if they can do 11 activities of daily living – getting up, shopping, eating, talking on the phone, doing finances – without help. If not, you rank lower. “
“This is disability.”
However, Lepofsky said he was unable to discuss the organization’s concerns with the minister or ministry officials. “The only counseling that’s even being given is a non-governmental facility called the Bioethics Table. Our consultations with them were last summer – until August 31st – and then a meeting practically on December 17th. Many of us said we needed more time and we needed to prepare. “
Since the draft was released on Jan. 13, Lepofsky said the group had received no further contact.
Ena Chadha, chief commissioner of the Ontario Human Rights Commission, told PressProgress that the OHRC had told the government for over a year that it needed to consult with concerned attorneys for people with disabilities about a triage protocol. Chadha said that hadn’t happened yet.
While an advisory body, the Bioethics Table, consulted some affected groups ahead of the January 13 drafts, Chadha said since December 2020 that no other notable consultations appear to have followed. “Since then, human rights experts and vulnerable groups disproportionately affected by the COVID-19 pandemic, including people with disabilities, the elderly, indigenous peoples and racialized communities, have not been consulted on these latest protocols.”
“You have a right to be clear and certain about how decisions about the triage of life and death would affect you. Doctors who would be forced to make these difficult decisions deserve the same clarity and assurance, ”said Chadha.
“Human rights groups are concerned that, despite the minister’s explicit remarks, the reality on the ground will be that the Emergency Standard of Care document distributed to hospitals in January will be used anyway.”
On April 28, the Ontario Medical Association hosted a panel with Lawrence Loh, Medical Officer of the Peel Region and Samantha Hill, Director of OMA, entitled “Making Difficult Decisions During the Pandemic.” On the agenda was: “Who should be ventilated when resources are limited?”
A spokesman for the OMA confirmed that the discussion is “focused on existing guidelines” as proposed by Critical Care Services on Jan. 13.
“We have been informed that the triage protocol can be initiated in a matter of days,” a doctor from Markham Stouffville Hospital told PressProgress. “You have been talking about this for a while. I can’t believe that myself and my colleagues are being asked to make life and death decisions for people. “
There is also a memo from the beginning of May that was received by the globe from Ontario’s Critical Care Command Center signaled that the health system had plans to use the existing drafts. The memo cautiously pointed out that recent capacity increases may mean that “we do not need to enable the emergency standard for nursing or recommend the use of the triage protocol”.
Community Living CEO Chris Beesley said his organization was frustrated by a lack of communication from the Ontario Department of Health.
“Since last spring we have been working with a coalition of disabled organizations to achieve transparency about the triage protocol,” Beesley told PressProgress.
However, Beesley said, “Neither Minister Elliott nor anyone on her staff had communicated with us since last July.”
Arch Disability Law Center attorney Mariam Shanouda told PressProgress, “We have never been consulted by the Department of Health.”
“We have now met several times with the bioethics table, a table the ministry posted to advise them on the triage protocol. The last time we were invited to meet the bioethics table was in December 2020, which is particularly worrying as the latest version of the triage protocol is dated January 13, 2021, ”Shanouda said. The organization said it has not been consulted since then.
Six members of the bioethics table in Ontario also warned on April 15 that “without public discussion, the vulnerability of already marginalized groups will be increased and trust undermined”.
PressProgress reached out to Critical Care Services to respond to concerns from supporters that the consultations were inadequate and the draft it sent out could be discriminatory. CCSO referred PressProgress to member of the bioethics table, Dr. James Downar, who, as reported by CBC News, drafted the January 13th draft.
Dr. Downar told PressProgress:
“The contingency standard is an emergency plan that can be used as a last resort. It was based on recommendations elaborated by the Ontario COVID-19 Bioethics Table, which had extensive consultations with multiple stakeholders, including disability advocates and the Ontario Human Rights Commission. Consultations will continue and the process of creating, reviewing, and updating a triage plan should always be an ongoing process, responding to changing conditions, emerging evidence, and an evolving understanding of the ethical, social, and legal implications. “
The Ontario Department of Health did not respond to PressProgress’ requests for comment.
On April 27, the department requested special medical assistance from the Canadian Armed Forces as the number of COVID-19 intensive care patients in hospitals rises. “
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