Ontario ICUS could reach ‘gridlock’ by February
Medical staff seek guidance on life-or-death decisions: ‘It’s really concerning not to know what the plan is’
TORONTO — As intensive care units in Ontario hospitals continue to fill up with COVID-19 patients, the province has yet to finalize a plan on who should get life-saving care when health resources are limited.
The latest COVID-19 projections show the province’s ICUS could reach “gridlock” by midto-late February.
At that point, health-care workers will have to decide who gets an ICU bed and who doesn’t — a practice known as critical care triage.
“It’s really concerning to not know what the plan is and transparency around that would go a long way towards everyone’s ability to prepare and everyone’s mental well-being,” said Dr. Samantha Hill, the president of the Ontario Medical Association, which represents more than 40,000 physicians.
The province has stumbled in its efforts to get the critical care triage ethical framework out to doctors.
Ontario Health sent out a critical care triage protocol on March 28, 2020, but retracted it several months later after an outcry from human rights organizations.
“The first protocol was horrifically discriminatory against patients with disabilities,” said David Lepofsky, the chairman of Accessibility for Ontarians with Disabilities Act Alliance.
One problem with that proposal was the use of a “clinical frailty scale,” or CFS, Lepofsky said.
The scale is also part of a proposed framework sent to the government by the Bioethics Table, which advises the province on the health system’s response to COVID-19.
The document — titled “Critical Care Triage during Major Surge in the COVID-19 Pandemic: Proposed Framework for Ontario” — lays out how a patient would qualify or be excluded from critical care and was sent to the province in September.
The clinical frailty scale is used as a prognostic tool for progressive illnesses that assesses a patient’s general deterioration over time, the Bioethics Table notes in the document, which was obtained by The Canadian Press.
However, the proposal acknowledges that the CFS “would seem to conflate disability with frailty and hence would contribute to over-triaging of persons with disabilities.”
It further notes that the CFS “illustrates how clinical evidence and experience are not sufficient alone to establish the justifiable use of a clinical tool and calls attention to the embedding of social norms within clinical tools and in their application in practice.”
The Ontario Human Rights Commission has also expressed concern about the recommendation that patients be evaluated for their survival potential over the next 12 months.
Ena Chadha, the chief commissioner of the Ontario Human Rights Commission, said the 12-month time period is troubling.
“A doctor can make a decision in the short term: is this person going to survive next week, the next two weeks,” she said.“but when you start looking at one year...you are going to be infused with discriminatory ideas about the person’s disability and age. “Our stakeholders would like to see a much shorter time frame.”