Group decries virus triage secrecy
Letter seeks transparency on province’s priority protocols for hospitals
A coalition of disability rights groups is calling on Doug Ford’s government to make public the directions they plan to give hospitals about how to decide who should be prioritized for lifesaving treatment if intensive care units become overwhelmed with COVID-19 patients.
The call comes after the government’s initial COVID-19 triage protocol — which leaked in March, but was never officially released — was rescinded after it was criticized for discriminating against people with disabilities. “We write about a life-anddeath issue now facing Ontarians,” reads the open letter, signed by more than 60 organizations and sent Thursday to Ford, Health Minister Christine Elliott and Raymond Cho, the minister responsible for seniors and accessibility.
The letter calls on the province to immediately release the latest recommendations from its Bioethics Table — the government-appointed group of physicians and bioethicists advising the ministry on a number of COVID-related issues — and ensure that any new triage guidelines “respect the constitutional and human rights of all patients, including patients with disabilities.”
The purpose of a triage protocol, which would be invoked only if critical care resources needed to be rationed, is to minimize overall mortality by prioritizing patients with the best chance of survival.
Among the concerns raised by disability advocates about the government’s initial protocol was its inclusion of the Clinical
Frailty Scale, a nine-point grading tool they said was inherently discriminatory against people with disabilities and could lead to their exclusion from life-saving treatment.
In their letter, the organizations commend the government for rescinding the initial protocol, but the fact that nothing has taken its place also poses a danger. “If critical care triage becomes necessary, decisions over who gets refused lifesaving critical care would be wrongly left to individual hospitals and doctors without safeguards against the serious danger of arbitrary and discriminatory decisions made because of disability,” the letter reads.
Roberto Lattanzio, executive director of the ARCH Disability Law Centre, said the province needs to ensure any new policy protects the rights of people with disabilities. “The pandemic doesn’t give governments a pass on ensuring that human rights and constitutional rights are respected,” he said. “We’ve been advocating for a framework free of discrimination for eight months now, and now we find ourselves in a very similar situation as we did from the outset.”
While the number of active COVID-19 cases in Ontario is nearly three times as high as during the peak of the first wave, hospitalizations and admissions to intensive care units (ICUs) are lower now than they were then. On Wednesday, the province reported that 656 people were hospitalized with COVID-19, including183 people in ICUs. On May 1, by comparison, there were more than1,000 patients in hospital, including
225 in ICUs.
The province significantly expanded its critical care capacity in April, increasing the number of ICU beds by nearly 1,500 to a total of 3,504. Roughly half of the province’s ICU beds were occupied as of Dec. 1, according to Critical Care Services Ontario’s daily report.
Last month, in response to a question in the legislature from the NDP, Progressive Conservative MPP Robin Martin confirmed the government had rescinded its initial protocol, which she said was only a draft, and that a “revised framework may be shared … should pandemic conditions deteriorate significantly.” But, Martin said: “We don’t anticipate getting anywhere near having to use such a protocol.”
David Lepofsky, chair of the Accessibility for Ontarians with Disabilities Act Alliance, said cases have steadily increased since Martin’s assurances, and the lack of action by the government is inexcusable. “They can’t wait until the day where they need triage and then say, ‘By the way, here are the rules.’ ”
The Health Ministry sent a statement saying it asked the Bioethics Table to “ensure that concerns and perspectives of those representing Indigenous people, Black and racialized communities, persons with disabilities, and others who may be disproportionately affected by critical care triage due to systemic discrimination, are meaningfully considered and reflected in a revised protocol.” A spokesperson did not respond when asked whether the government would make the revised protocol public.