New York hospitals could use LOTTERIES for ventilators in an extreme shortage during coronavirus emergency – and other states plan to DENY access to those with cancer or a mental disability

Saturday, March 28, 2020
By Paul Martin

There is no national protocol for rationing ventilators and each state has its own
In New York, ethical guidance calls for lottery if there’s equal chance of recovery
In Alabama, protocol says those with mental disabilities may be poor candidates
That policy applies even to children, outraging disability rights group
Washington state’s emergency protocol drew similar complaints
Coronavirus symptoms: what are they and should you see a doctor?

28 March 2020

State emergency plans to ration ventilators if the coronavirus pandemic worsens are raising thorny ethical questions, as New York considers lotteries for access to the machines and other states contemplate denying them to those with mental disabilities.

The White House says that as yet, no one has been denied a ventilator who needed one. But as the crisis deepens, several states are putting grim plans in place to ration the vital machines.

In New York, the state’s ethical guidelines for allocating ventilators in a pandemic call for devoting scarce resources to the patients who are most likely to be saved.

However, the New York report concluded that in the rare case when multiple patients are equally likely to recover, but there are limited resources to help them, hospitals should ‘utilize “random selection” (e.g., lottery) methods.’

The panel concluded that a lottery was more equitable than treating people on a first-come, first-serve basis, which could disadvantage ‘those who are of lower socio-economic means who may not have access to information about the pandemic or to reliable transportation, or minority populations who might initially avoid going to a hospital because of distrust of the health care system.’

The New York guidelines are not binding, and hospitals there are already forming their own ethics panels to determine how to ration care in the event of a critical shortage — a scene that has already played out tragically in Italy.

Meanwhile, in the absence of national protocols, states around the country have been devising their own, some of which have drawn outrage from disability rights advocates.

On Tuesday, Alabama’s Emergency Operations Plan for mechanical ventilator triage was the subject of a complaint to the U.S. Department of Health and Human Services’ Office for Civil Rights.

In the event of a crisis shortage, the Alabama protocol lists several health conditions for which providers should ‘not offer mechanical ventilator support,’ including heart failure, respiratory failure and metastatic cancer.

It also says ‘persons with severe mental retardation, advanced dementia or severe traumatic brain injury may be poor candidates for ventilator support.’

Those categories could include people with Alzheimer’s, as well as people of any age with disabilities such as Down syndrome, outraging disability rights advocates.

Alabama ‘is poised to make life-and-death decisions that will deny needed medical treatment to countless individuals based entirely on their underlying disabilities,’ the complaint says.

‘The mere fact that a person has an intellectual or cognitive disability cannot be a basis for denying care or making that person a lower priority to receive treatment.’

‘In this time of crisis, we cannot devalue the lives of others in our community based on their disabilities. It’s morally wrong, and it violates the law,’ said James Tucker, Director of the Alabama Disabilities Advocacy Program, in a statement.

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