When Italy's COVID-19 crisis started in earnest, doctors described the difficult life-or-death decisions they were forced to make about which patients to try and save with scarce resources in terms of wartime triage. Now that the U.S. faces the real risk of a similar tsunami of coronavirus patients flooding hospitals, states and local health care systems are preparing criteria in case the number of seriously ill COVID-19 patients exceeds the number of ICU beds or ventilators.
An internal draft "worst case scenario" letter from Henry Ford Health System in Michigan leaked Thursday night, for example, said in case of ventilator or ICU shortages, "patients who have the best chance of getting better are our first priority."
"Medical triage always forces hard decisions about who lives and dies," Amy Silverman reports at the Arizona Daily Star and ProPublica. Typically, "older people with shorter life expectancy or those with severe dementia are often deemed less deserving of scarce medical resources," but the disaster preparedness plans in Washington State, Alabama, and other states "make clear that the fate of those with intellectual disabilities is part of the wrenching debate."
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Advocates for people with Down syndrome, autism, cerebral palsy, and other intellectual disabilities filed complaints this week, with the Health and Human Services Department's civil rights division, seeking clarity about the Alabama and Washington plans. Alabama's emergency plan, for example, says "persons with severe mental retardation, advanced dementia, or severe traumatic brain injury may be poor candidates for ventilator support." Other states, like Arizona, use more nebulous language about allocating scarce resources to "patients whose need is greater or whose prognosis is more likely to result in a positive outcome."
"What we're seeing here is a clash between disability rights law and ruthless utilitarian logic," disability policy expert Ari Ne'eman at Brandeis University told Silverman. "What this is really about at the end of the day is whether our civil rights laws still apply in a pandemic. I think that's a pretty core question as to who we are as a country."
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