Ontario COVID-19 Surge Could Force Doctors to Use Online Calculator to Make Life-and-Death Decisions


Published March 28, 2021

If COVID-19’s surging third wave overwhelms Ontario’s hospitals, doctors could soon be using an emergency triage protocol that includes an online calculator to help decide who gets lifesaving care and who does not.

The website, which prompts physicians to key in a critical patient’s diagnosis in order to estimate their chances of survival, is part of an emergency procedure drafted to help doctors make what would normally be unthinkable decisions. The protocol has been distributed to hospitals. But it has never officially been made public.

The province has loosened some pandemic restrictions in recent weeks, even as daily new infections still shoot upward, with more than 2,448 recorded on Sunday and 19 deaths. Ontario counted 390 COVID-19 patients in its intensive-care units, not far from the peak of 420 hit in the second wave of the virus in January.

While the provincial government says it has added hospital capacity, the Ontario Hospital Association warned last Friday that the province’s critical-care system was reaching its “saturation point” and that soon “hospitals will be under extraordinary pressure to try and ensure equitable access to lifesaving critical care.”

To deal with the onslaught, ICUs have been transferring critical patients from packed facilities to those elsewhere that still have space. Patients are being shipped via ambulance helicopter from Toronto to as far away as Kingston. Field hospitals have also sprung up around several health care facilities, including Toronto’s Sunnybrook Health Sciences Centre.

But more than a year into a pandemic that put hospitals in New York and Italy over the brink, the Ontario government has kept almost all planning for such a worst-case scenario out of the public eye. By contrast, Quebec held open consultations on its emergency triage protocol months ago.

Meanwhile, the Ontario Human Rights Commission and disability rights groups have raised objections for months, warning that leaked drafts of the protocol discriminate unfairly against older and disabled people.

Both a January version of the protocol, developed by the group that co-ordinates critical care across the province, and the online calculation tool have only come to light after being obtained by the Accessibility for Ontarians with Disabilities Act Alliance, a disability rights group. The AODAA has also obtained a “framework document,” prepared by the government’s bioethics table, a committee of experts that has been wrestling with the triage issue for the past year.

The province’s Ministry of Health has said only that the triage protocol, known as an “emergency standard of care,” was drafted by the medical profession and not approved by the ministry.

The notion of an online triage aide may sound strange, but nothing about hospitals swamped by COVID-19 would be normal. The “short-term mortality risk” calculator would allow physicians to type data on the severity of a patient’s conditions ” cancer, trauma, stroke and so on ” to help come up with an estimated chance of survival after 12 months. Those with a higher chance of survival would be given priority for ICU spots. Decisions would be made by two doctors, not one alone.

David Lepofsky, a lawyer and chairman of the AODAA, said it’s the wrong approach.

“It creates the false impression that this can be an objective [task]. Just type in the data, press the button, the computer will tell you who lives and who dies,” Mr. Lepofsky said in an interview.

He takes issue with the protocol’s reliance on a metric for use on those over 65 known as the clinical frailty scale, which measures a patient’s ability to perform various everyday tasks. That, he argues, devalues the lives of disabled people.

James Downar, a specialist in critical care at The Ottawa Hospital and a drafter of the triage plan who sits on the province’s bioethics table, said the online calculator is no different than the paper version that doctors can also use under the protocol.

He said using a scoring system, such as the clinical frailty scale, to evaluate patients is meant to limit the scope of a doctor’s subjective judgements or bias, in order to try to ensure everyone is treated equally. The protocol, he said, is focused on a patient’s risk of mortality at 12 months, not whether they have a disability.

“None of us want to be in a triage scenario,” Dr. Downar said. “The purpose of a triage system is to reduce the number of preventable deaths and reduce the number of people who are denied critical care.”

Dr. Downar said he believed it would be best to make the triage plans public.

“I think the simplest way to address many of these concerns would be to simply show people what the document is,” Dr. Downar said. “This is a document whose goal is to treat people fairly and to try to save lives. Why would we possibly want to hide that?”

A spokeswoman for Ontario Health Minister Christine Elliott referred questions about the protocol to Jennifer Gibson, the co-chair of the government’s bioethics table and director of the University of Toronto Joint Centre for Bioethics.

Dr. Gibson said the bioethics table has been in discussions with the Ontario Human Rights Commission on addressing its concerns with the triage protocol. She also said the table has previously recommended an open public consultation on the triage issue ” but that the government had so far not acted on this idea.

“We provide advice. And that advice may be taken or it may not be taken,” Dr. Gibson said.

Even with ICUs at a tipping point, Dr. Gibson said she didn’t think it was too late to start a more open discussion of the issues at stake, to build public trust.

Earlier this month, the chief commissioner of Ontario’s Human Rights Commission, Ena Chadha, wrote to Ms. Elliott to reiterate concerns about the protocol, the potential for discrimination against the disabled and a lack of consultation and transparency around it. Ms. Chadha and other groups have been at odds with the government over the issue since last March.

“We have to develop a framework that is equitable, with human-rights considerations being paramount. Which means it can’t be built on ageist or ableist notions, or assumptions about quality of life,” she said. “This is the problem.”

The Opposition NDP’s critic for accessibility and persons with disabilities, Ottawa Centre MPP Joel Harden, called the notion of using an online mortality calculator to determine the fate of a patient “chilling.” He called the protocol “insulting” to the disabled, and urged the government to have it debated in the open.

“We can’t just have these love-in press conferences,” Mr. Harden said. “We have to have some challenging conversations.”

Michael Warner, the head of critical care at Michael Garron Hospital in Toronto’s east end, said ICU doctors have been familiarized with the emergency triage protocol ” even though the government says it remains unapproved ” and that committees at hospitals across the province to oversee it have been set up. He held up a paper triage form in a Twitter video on Friday, urging Premier Doug Ford to tighten public-health measures.

He also criticized the government for so far declining to say it would, if needed, issue an order to override Ontario’s health care legislation and allow for the withdrawal of lifesaving care from patients already in the ICU who are unlikely to survive. Under the plan as it stands now, only new patients would face ICU triage.

It’s unclear, Dr. Warner warned, how the plans would roll out in what would be an unprecedented crisis.

“This could be battlefield medicine,” he said. “We may end up having to improvise.”

Original at https://www.theglobeandmail.com/canada/article-ontario-covid-19-surge-could-force-doctors-to-use-online-calculator-to/




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Coronavirus: Ford taps Gen. Rick Hillier to lead vaccine distribution task force



Ontario Premier Doug Ford announced Monday that Gen. Rick Hillier would head up a task force charged with distributing a COVID-19 to Ontarians once one is approved, saying that distributing the vaccine would be “the largest logistical undertaking in a generation.”



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The Accessible Canada Act Comes into Force Today – Download and Read the Legislation in English or French – AODA Alliance


Accessibility for Ontarians with Disabilities Act Alliance Update

United for a Barrier-Free Society for All People with Disabilities

www.aodaalliance.org [email protected] Twitter: @aodaalliance

The Accessible Canada Act Comes into Force Today – Download and Read the Legislation in English or French

July 11, 2019

          SUMMARY

Today, the Federal Government proclaimed the Accessible Canada Act in force. It was recently passed by the House of Commons and Senate and was given Royal Assent. The law comes into force when the Federal Cabinet so orders. In a news release earlier today, set out below, the Cabinet proclaimed it in force.

The Federal Government’s news release makes commitments on what this law will do. we will be vigilant to hold the Federal Government to any and all of its commitments. For example, in its news release, the Federal Government promises:

“With this legislation in place, millions of Canadians with disabilities can rely on the Government of Canada to remove the barriers that hinder their full participation in society.”

Would you like to read the Accessible Canada Act in its final form? At last, we just recently received from Parliament electronic copies of the finalized wording of the law in English and French. You can get these in MS Word or pdf format by visiting https://www.aodaalliance.org/canada/download-the-final-text-of-the-accessible-canada-act-as-passed-by-canadas-parliament-previously-called-bill-c-81-in-english-or-french-and-in-an-accessible-ms-word-or-a-pdf-format/

We also invite you to read the AODA Alliance ‘s 7 preliminary reflections we recently made about the final enactment of the Accessible Canada Act.

Since it is now a law, we no longer call it Bill C-81. A bill is a proposed law, that has not yet become a law.

Watch for future AODA Alliance Updates where we will map out our next steps in our campaign to ensure that this new legislation is effectively implemented.

          MORE DETAILS

Text of the Federal Government’s July 11, 2019 News Release

Originally posted at https://www.canada.ca/en/employment-social-development/news/2019/07/canadas-first-federal-accessibility-legislation-comes-into-force.html

Employment and Social Development Canada

Canada’s first federal accessibility legislation comes into force

News release

July 11, 2019             Gatineau, Quebec              Employment and Social Development Canada

Accessibility in Canada is about creating communities, workplaces and services that enable everyone to participate fully in society without barriers. The Government of Canada believes that all Canadians deserve the same opportunities and chances at success and is pleased to announce the coming into force of the Accessible Canada Act. Reaching this milestone demonstrates the Government’s commitment to implement this transformational legislation in a timely manner, creating more opportunities for persons with disabilities and ensuring greater access for all Canadians.

The coming into force of the Accessible Canada Act establishes a framework to create a barrier-free Canada through the proactive identification, removal and prevention of accessibility barriers. It will also ensure that persons with disabilities are no longer required to fight barriers to accessibility on an individual basis. With this legislation in place, millions of Canadians with disabilities can rely on the Government of Canada to remove the barriers that hinder their full participation in society.

The Accessible Canada Act applies to the federally regulated private sector, which includes the banking, transportation and telecommunications sectors, as well as the Government of Canada, Crown corporations and Parliament. Under the Act, these organizations will be required to develop and publish accessibility plans that describe how they will identify, remove and prevent barriers to accessibility. They will also be required to establish a mechanism for receiving and addressing feedback on accessibility from anyone who interacts with their organization. Finally, they will have to develop regular progress reports on the implementation of their plan and addressing any feedback they receive.

The Accessible Canada Act also establishes new structures and positions, including:

  • the Canadian Accessibility Standards Development Organization (CASDO), led by a board of directors comprised of a majority of persons with disabilities that will develop accessibility standards in collaboration with the disability community and industry;
  • a Chief Accessibility Officer, who will advise the Minister of Accessibility and monitor systemic and emerging accessibility issues; and
  • an Accessibility Commissioner, who will spearhead compliance and enforcement activities under the legislation.

The next phase of implementation will include the development of standards and regulations that will provide clear guidance on accessibility requirements.

The new legislation is built on a whole-of-government approach to accessibility. Existing regulators and complaints bodies—such as the Canadian Transportation Agency, the Canadian Radio-television and Telecommunications Commission, the Canadian Human Rights Commission and the Federal Public Sector Labour Relations and Employment Board—are required to collaborate to put in place a mechanism for the efficient and expeditious referral of accessibility-related complaints and to foster complementary accessibility policies and practices.

The coming into force of the Accessible Canada Act also legislates National AccessAbility Week as beginning each year on the last Sunday in May, with the objective of promoting accessibility and celebrating the contributions of persons with disabilities across the country.

Quotes

“Today marks a major milestone in the history of disability rights. I am so proud that the Accessible Canada Act has now come into force and is a reality. This important achievement would not have been possible without the dedication and engagement of the disability community and I thank them for their hard work. With this legislation now in place, we can begin a journey that will lead us to a society that treats all people with the dignity they deserve. Now more than ever, we can say: Nothing without us!”

– The Honourable Carla Qualtrough, Minister of Public Services and Procurement and Accessibility

Quick facts

  • Approximately one in five Canadians, or about 6.2 million people aged 15 and over, report having a disability that limits them in their daily activities.
  • The Accessible Canada Act was developed following the most inclusive and accessible consultations with the disability community in our country’s history. More than 6,000 Canadians and 100 accessibility organizations shared their views and ideas about an accessible Canada.

Contacts

For media enquiries, please contact:

Marielle Hossack

Press Secretary

Office of the Honourable Carla Qualtrough

819-956-3239

[email protected]

Media Relations Office

Employment and Social Development Canada

819-994-5559

[email protected]



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The Accessible Canada Act Comes into Force Today


Accessibility for Ontarians with Disabilities Act Alliance Update United for a Barrier-Free Society for All People with Disabilities http://www.aodaalliance.org [email protected] Twitter: @aodaalliance

July 11, 2019

SUMMARY

Today, the Federal Government proclaimed the Accessible Canada Act in force. It was recently passed by the House of Commons and Senate and was given Royal Assent. The law comes into force when the Federal Cabinet so orders. In a news release earlier today, set out below, the Cabinet proclaimed it in force.

The Federal Government’s news release makes commitments on what this law will do. we will be vigilant to hold the Federal Government to any and all of its commitments. For example, in its news release, the Federal Government promises:

“With this legislation in place, millions of Canadians with disabilities can rely on the Government of Canada to remove the barriers that hinder their full participation in society.”

Would you like to read the Accessible Canada Act in its final form? At last, we just recently received from Parliament electronic copies of the finalized wording of the law in English and French. You can get these in MS Word or pdf format by visiting https://www.aodaalliance.org/canada/download-the-final-text-of-the-accessible-canada-act-as-passed-by-canadas-parliament-previously-called-bill-c-81-in-english-or-french-and-in-an-accessible-ms-word-or-a-pdf-format/

We also invite you to read the AODA Alliance ‘s 7 preliminary reflections we recently made about the final enactment of the Accessible Canada Act.

Since it is now a law, we no longer call it Bill C-81. A bill is a proposed law, that has not yet become a law.

Watch for future AODA Alliance Updates where we will map out our next steps in our campaign to ensure that this new legislation is effectively implemented.

MORE DETAILS

Text of the Federal Government’s July 11, 2019 News Release

Originally posted at https://www.canada.ca/en/employment-social-development/news/2019/07/canadas-first-federal-accessibility-legislation-comes-into-force.html

Employment and Social Development Canada

Canadas first federal accessibility legislation comes into force

News release
July 11, 2019 Gatineau, Quebec Employment and Social Development Canada

Accessibility in Canada is about creating communities, workplaces and services that enable everyone to participate fully in society without barriers. The Government of Canada believes that all Canadians deserve the same opportunities and chances at success and is pleased to announce the coming into force of the Accessible Canada Act. Reaching this milestone demonstrates the Governments commitment to implement this transformational legislation in a timely manner, creating more opportunities for persons with disabilities and ensuring greater access for all Canadians.

The coming into force of the Accessible Canada Act establishes a framework to create a barrier-free Canada through the proactive identification, removal and prevention of accessibility barriers. It will also ensure that persons with disabilities are no longer required to fight barriers to accessibility on an individual basis. With this legislation in place, millions of Canadians with disabilities can rely on the Government of Canada to remove the barriers that hinder their full participation in society.

The Accessible Canada Act applies to the federally regulated private sector, which includes the banking, transportation and telecommunications sectors, as well as the Government of Canada, Crown corporations and Parliament. Under the Act, these organizations will be required to develop and publish accessibility plans that describe how they will identify, remove and prevent barriers to accessibility. They will also be required to establish a mechanism for receiving and addressing feedback on accessibility from anyone who interacts with their organization. Finally, they will have to develop regular progress reports on the implementation of their plan and addressing any feedback they receive.

The Accessible Canada Act also establishes new structures and positions, including:

the Canadian Accessibility Standards Development Organization (CASDO), led by a board of directors comprised of a majority of persons with disabilities that will develop accessibility standards in collaboration with the disability community and industry;
a Chief Accessibility Officer, who will advise the Minister of Accessibility and monitor systemic and emerging accessibility issues; and
an Accessibility Commissioner, who will spearhead compliance and enforcement activities under the legislation.

The next phase of implementation will include the development of standards and regulations that will provide clear guidance on accessibility requirements.

The new legislation is built on a whole-of-government approach to accessibility. Existing regulators and complaints bodiessuch as the Canadian Transportation Agency, the Canadian Radio-television and Telecommunications Commission, the Canadian Human Rights Commission and the Federal Public Sector Labour Relations and Employment Boardare required to collaborate to put in place a mechanism for the efficient and expeditious referral of accessibility-related complaints and to foster complementary accessibility policies and practices.

The coming into force of the Accessible Canada Act also legislates National AccessAbility Week as beginning each year on the last Sunday in May, with the objective of promoting accessibility and celebrating the contributions of persons with disabilities across the country.

Quotes

Today marks a major milestone in the history of disability rights. I am so proud that the Accessible Canada Act has now come into force and is a reality. This important achievement would not have been possible without the dedication and engagement of the disability community and I thank them for their hard work. With this legislation now in place, we can begin a journey that will lead us to a society that treats all people with the dignity they deserve. Now more than ever, we can say: Nothing without us!
The Honourable Carla Qualtrough, Minister of Public Services and Procurement and Accessibility

Quick facts

Approximately one in five Canadians, or about 6.2 million people aged 15 and over, report having a disability that limits them in their daily activities.

The Accessible Canada Act was developed following the most inclusive and accessible consultations with the disability community in our countrys history. More than 6,000 Canadians and 100 accessibility organizations shared their views and ideas about an accessible Canada.

Contacts

For media enquiries, please contact:
Marielle Hossack
Press Secretary
Office of the Honourable Carla Qualtrough
819-956-3239
[email protected]

Media Relations Office
Employment and Social Development Canada
819-994-5559
[email protected]



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