Disability, Disablism, and COVID-19 Pandemic Triage
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SYMPOSIUM: COVID-19
Disability, Disablism, and COVID-19 Pandemic Triage Jackie Leach Scully
Received: 22 April 2020 / Accepted: 27 July 2020 # Journal of Bioethical Inquiry Pty Ltd. 2020
Abstract Pandemics such as COVID-19 place everyone at risk, but certain kinds of risk are differentially severe for groups already made vulnerable by pre-existing forms of social injustice and discrimination. For people with disability, persisting and ubiquitous disablism is played out in a variety of ways in clinical and public health contexts. This paper examines the impact of disablism on pandemic triage guidance for allocation of critical care. It identifies three underlying disablist assumptions about disability and health status, quality of life, and social utility, that unjustly and potentially catastrophically disadvantage people with disability in COVID-19 and other global health emergencies. Keywords Disability . COVID-19 . Pandemic . Global health emergencies . Critical care . Rationing . Allocation . Discrimination . Disablism
Background In many countries affected by COVID-19 during early to mid-2020, healthcare planners and practitioners were or anticipated being confronted with an unfamiliar situation of extreme critical care rationing. A minority of the people infected by the SARS-CoV-2 virus become severely ill and eventually progress to needing intensive care including J. L. Scully (*) University of New South Wales, Sydney, NSW 2052, Australia e-mail: [email protected]
mechanical ventilation, and demand for these resources has in some cases significantly exceeded supply. Later on, the same may apply to scarce antiviral treatment or vaccines as they become available. Decisions have to be made about which of the people who could potentially benefit get access to life-saving critical care if not all can. In any situation of pandemic triage, policymakers, the writers of guidelines, and frontline medical staff need guidance on how to make those decisions in the most humane and morally justifiable way, while patients, families, and the general public want to know the basis on which such decisions are being made. During major health emergencies such as pandemics, resource allocation conventionally follows broadly utilitarian and egalitarian ethics. Although it would be an oversimplification to say that healthcare switches completely from a focus on individual patient interests to utilitarianism, there is a shift towards the public health logic of maximizing the good for the greatest number of people, while remaining committed to equality of treatment. The inevitable result is tension between imperatives, expectations, and customary practice. In the early weeks and months of the COVID-19 pandemic a number of critical care guidelines and protocols were produced, primarily in countries with reasonably well-developed public health systems including Australia, the United States, several European countries, and the United Kingdom, with recommendations directed at various levels from national down to individua
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