03/29/2020
Important news for healthcare providers dealing with bioethical issues related to problems such as the availability of ventilators: The HHS Office of Civil Rights says it’s unlawful to deny medical care on the basis of quality of life, disabilities or age.
This does not end the discussion regarding how to apply triage principles to COVID-19 patients, but it is certainly part of that discussion. I believe that what it means is that rather than having an arbitrary cut-off at a particular age, as Italy has apparently done at age 60, providers must rank patients by their level of acuity and their chances of survival. In the event of a ventilator shortage, those patients most likely to survive will be the ones who get access to that level of service. To avoid unwelcome government scrutiny and enforcement action, not to mention lawsuits, providers will have to document carefully and clearly why they are ranking certain patients ahead of others.
Key excerpt:
“OCR enforces the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, the Age Discrimination Act, and Section 1557 of the Affordable Care Act which prohibits discrimination in HHS funded health programs or activities. These laws, like other civil rights statutes OCR enforces, remain in effect. As such, persons with disabilities should not be denied medical care on the basis of stereotypes, assessments of quality of life, or judgments about a person’s relative ‘worth’ based on the presence or absence of disabilities or age. Decisions by covered entities concerning whether an individual is a candidate for treatment should be based on an individualized assessment of the patient and his or her circumstances, based on the best available objective medical evidence.”
The bulletin is here:
https://www.hhs.gov/sites/default/files/ocr-bulletin-3-28-20.pdf.
