Ford Government Finally Makes Public the Initial Recommendations by the K-12 Education Standards Development Committee on How to Make Ontario Schools Accessible for Students with Disabilities


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

June 1, 2021

At long last, the Ford Government today belatedly made public the initial or draft recommendations on what the promised Education Accessibility Standard should include. The Government-appointed K-12 Education Standards Development Committee submitted these initial or draft recommendations to the Government over two and a half months ago.

These will be available online for the public to submit feedback up to September 2, 2021, according to the Government announcement. That feedback will be sent to the K-12 Education Standards Development Committee. The K-12 Education Standards Development Committee is then required to review that feedback and take it into account as it works to finalize its recommendations for the Government.

In addition to finding them on the Ford Government’s website, you can go to the AODA Alliance’s website to find the K-12 Education Standards Development Committee’s initial recommendations at https://www.aodaalliance.org/wp-content/uploads/2021/06/Committee-Approved-K-12-Initial-Recommendations-Report-Submission-2021.docx In addition to finding it on the Government’s website, you can also go to the AODA Alliance website to download the survey that the Government created and is inviting the public to answer to give feedback on these draft recommendations at https://www.aodaalliance.org/wp-content/uploads/2021/06/K-12-Initial-Recommendations-Report-Survey-Word-Version.docx

In contravention of s, 10(1) of the AODA, the Ford Government has still not publicly posted the initial or draft recommendations of the Post-Secondary Education Standards Development Committee. On May 7, 2021 AODA Alliance Chair David Lepofsky had to resort to filing a court application, arguing that the Ford Government is in breach of its duty to post the initial or final recommendations it receives from these Standards Development Committees upon receiving them. You can read more about that court application in the May 7, 2021 AODA Alliance Update.

The Government finally posted the initial recommendations of the K-12 Education Standards Development Committee today, just two days before an upcoming conference call, scheduled for June 3, 2021 with a Superior Court judge. Lepofsky requested that call to ask that the Court schedule a hearing in court on his application as soon as possible on an urgent or expedited basis.

We will later have much to say about these initial or draft recommendations. AODA Alliance Chair David Lepofsky is a member of the K-12 Education Standards Development Committee. He took active part in the development of these initial recommendations. Lepofsky believes that the members of the K-12 Education Standards Development Committee with whom he worked did an excellent job of undertaking the most thorough top-to-bottom review of Ontario’s education system in decades, if not ever, from the perspective of students with disabilities. He shares the committee’s eagerness for public feedback to help with the finalization of these recommendations.

The AODA Alliance welcomes your feedback on these initial or draft recommendations. To assist us in preparing a written brief to submit to the K-12 Education Standards Development Committee, send your feedback to us at [email protected]

We want all Standards Development Committees that are now underway to get their finalized recommendations completed, submitted to the Ford Government, and posted publicly well before the Ontario Election campaign begins next spring. We want to be able to press all major political parties and candidates for commitments to detailed reforms in Ontario’s education and health care systems, to make them barrier-free for people with disabilities. Any delay in posting a Standards Development Committee’s initial or final recommendations hurts people with disabilities, delays progress on accessibility, and makes it harder for us to effectively avail ourselves of the democratic process during a provincial election.

Parents of students with disabilities can benefit from AODA Alliance Chair David Lepofsky’s captioned online video, already seen over 2,000 times. It offers practical tips on how to advocate for students with disabilities in the school system. This video fits well within the focus of the K-12 Education Standards Development Committee’s initial recommendations.

For more background on the AODA Alliances multi-year campaign to tear down the barriers facing students with disabilities at all levels of Ontario’s education system, check out the AODA Alliance website’s education page.

You can also read the AODA Alliance’s October 10, 2019 Framework for what the promised Education Accessibility Standard should include.

In honour of this week, National AccessAbility Week, read the report card that the AODA Alliance made public on the Ford Government’s performance on disability accessibility issues during its first three years in office. The Ford Government was awarded an “F” grade.




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Ford Government Finally Makes Public the Initial Recommendations by the K-12 Education Standards Development Committee on How to Make Ontario Schools Accessible for Students with Disabilities


Accessibility for Ontarians with Disabilities Act Alliance Update

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

Web: www.aodaalliance.org Email: [email protected] Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

Ford Government Finally Makes Public the Initial Recommendations by the K-12 Education Standards Development Committee on How to Make Ontario Schools Accessible for Students with Disabilities

June 1, 2021

At long last, the Ford Government today belatedly made public the initial or draft recommendations on what the promised Education Accessibility Standard should include. The Government-appointed K-12 Education Standards Development Committee submitted these initial or draft recommendations to the Government over two and a half months ago.

These will be available online for the public to submit feedback up to September 2, 2021, according to the Government announcement. That feedback will be sent to the K-12 Education Standards Development Committee. The K-12 Education Standards Development Committee is then required to review that feedback and take it into account as it works to finalize its recommendations for the Government.

In addition to finding them on the Ford Government’s website, you can go to the AODA Alliance’s website to find the K-12 Education Standards Development Committee’s initial recommendations at https://www.aodaalliance.org/wp-content/uploads/2021/06/Committee-Approved-K-12-Initial-Recommendations-Report-Submission-2021.docx

In addition to finding it on the Government’s website, you can also go to the AODA Alliance website to download the survey that the Government created and is inviting the public to answer to give feedback on these draft recommendations at https://www.aodaalliance.org/wp-content/uploads/2021/06/K-12-Initial-Recommendations-Report-Survey-Word-Version.docx

In contravention of s, 10(1) of the AODA, the Ford Government has still not publicly posted the initial or draft recommendations of the Post-Secondary Education Standards Development Committee. On May 7, 2021 AODA Alliance Chair David Lepofsky had to resort to filing a court application, arguing that the Ford Government is in breach of its duty to post the initial or final recommendations it receives from these Standards Development Committees upon receiving them. You can read more about that court application in the May 7, 2021 AODA Alliance Update.

The Government finally posted the initial recommendations of the K-12 Education Standards Development Committee today, just two days before an upcoming conference call, scheduled for June 3, 2021 with a Superior Court judge. Lepofsky requested that call to ask that the Court schedule a hearing in court on his application as soon as possible on an urgent or expedited basis.

We will later have much to say about these initial or draft recommendations. AODA Alliance Chair David Lepofsky is a member of the K-12 Education Standards Development Committee. He took active part in the development of these initial recommendations. Lepofsky believes that the members of the K-12 Education Standards Development Committee with whom he worked did an excellent job of undertaking the most thorough top-to-bottom review of Ontario’s education system in decades, if not ever, from the perspective of students with disabilities. He shares the committee’s eagerness for public feedback to help with the finalization of these recommendations.

The AODA Alliance welcomes your feedback on these initial or draft recommendations. To assist us in preparing a written brief to submit to the K-12 Education Standards Development Committee, send your feedback to us at [email protected]il.com.

We want all Standards Development Committees that are now underway to get their finalized recommendations completed, submitted to the Ford Government, and posted publicly well before the Ontario Election campaign begins next spring. We want to be able to press all major political parties and candidates for commitments to detailed reforms in Ontario’s education and health care systems, to make them barrier-free for people with disabilities. Any delay in posting a Standards Development Committee’s initial or final recommendations hurts people with disabilities, delays progress on accessibility, and makes it harder for us to effectively avail ourselves of the democratic process during a provincial election.

Parents of students with disabilities can benefit from AODA Alliance Chair David Lepofsky‘s captioned online video, already seen over 2,000 times. It offers practical tips on how to advocate for students with disabilities in the school system. This video fits well within the focus of the K-12 Education Standards Development Committee’s initial recommendations.

For more background on the AODA Alliances multi-year campaign to tear down the barriers facing students with disabilities at all levels of Ontario’s education system, check out the AODA Alliance website’s education page.

You can also read the AODA Alliance’s October 10, 2019 Framework for what the promised Education Accessibility Standard should include.

In honour of this week, National AccessAbility Week, read the report card that the AODA Alliance made public on the Ford Government’s performance on disability accessibility issues during its first three years in office. The Ford Government was awarded an “F” grade.



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Download in an accessible MS Word format the initial recommendations of the Health Care Standards Development Committee, made public on May 7, 2021, on What the Promised Health Care Accessibility Standard Should Include



Download in an accessible MS Word format the initial recommendations of the Health Care Standards Development Committee, made public on May 7, 2021, on What the Promised Health Care Accessibility Standard Should Include



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if Hospital Overloads Require Critical Care Triage, Will the Ford Government Agree to Tell the Public the Daily Numbers of Patients Refused Life-Saving Critical Care They Need?


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

April 27, 2021

SUMMARY

The AODA Alliance just wrote the Ford Government to request that key information about its critical care triage plans be immediately made public. That letter is set out below. The possibility that life-saving critical care will have to be rationed or “triaged” gets closer as ICUs get fuller and fuller.
We asked the Ford Government to release any critical care triage protocols for doctors to use for adult patients, for patients under 18, and for any patient if the Government tries to give doctors the terrifying power to remove critical care from patients without their consent.
We ask for any directions or draft directions for ambulance crews on whether or when they should refuse life-saving care to a patient needing it when called to an emergency. We ask for results of practice drills run by Ontario hospitals on how they’d decide who gets refused life-saving critical care. The public should know how differently each hospital would deal with this.
Every day, the Government makes public statistics on the number of new COVID-19 cases, the number of patients in ICUs, and the number of COVID-19 deaths. We ask the Ford Government to commit that if critical care triage must take place, the Government will make public the number of patients each day who are refused critical care they need due to triage. The public has a right to know this and all the information we seek.
Our requests build in part on a very disturbing article in the April 26, 2021 Globe and Mail by reporter Jeff Gray. We set that article out below and quote it in our letter to the Ford Government.
Will the Ford Government answer this letter, provide the information we seek, and have its officials speak to us about our concerns? As the letter explains, the Government refused to answer any of the eight earlier well-researched letters that we sent on this topic. Its officials, all the way up to the Health Minister, have not met with us or spoken to us about our concerns. The Premier’s Office has been no better.
We keep hearing from people with disabilities that they are frightened and angry about the Ford Government’s approach to this critical care triage issue. This is so especially after they have had to put up with a year of suffering disproportionately from the COVID-19 pandemic and from the Ford Government’s ongoing failure to effectively address their urgent needs in its emergency planning. The Ford Government’s relentless secrecy in this area fuels that anger and fear.
We deeply appreciate the hard work of our front-line health professionals and all health care workers who are trying to cope with the ICU overload that keeps spiraling out of control. We believe that doctors don’t want to have to undertake critical care triage. We also believe that they don’t want the Ford Government to set them up to engage in disability discrimination if that critical care triage must take place. To learn more about this issue, visit the AODA Alliance’s health care web page. MORE DETAILS
April 26, 2021 AODA Alliance Letter to Ontario Health Minister Christine Elliott

Accessibility for Ontarians with Disabilities Act Alliance
United for a Barrier-Free Society for All People with Disabilities Web: www.aodaalliance.org Email: [email protected] Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

April 26, 2021

To: The Hon. Christine Elliott, Minister of Health
Via email: [email protected]
Ministry of Health
5th Floor
777 Bay St.
Toronto, ON M7A 2J3

Dear Minister,

Re: Ontario’s Plans for Medical Triage of Life-Saving Critical Care in the Event Hospitals Cannot Handle All COVID-19 Cases

We are in a crisis. Ontario is very close to having to ration or triage life-saving critical care. This is because hospitals have record-breaking demands on intensive care units.

For over a year, people with disabilities have disproportionately suffered from the pandemic’s worst hardships. Under Ontario’s critical care triage plans, they are in danger of also suffering from disability discrimination in access to life-saving critical care. Disability discrimination fatally infects the January 13, 2021 Critical Care Triage Protocol.

For example, if a cancer patient needs critical care, they will be deprioritized if a patient is “Completely disabled and cannot carry out any self-care; totally confined to bed or chair”. As another example, if a patient needing critical care is over 65 and has a progressive disease (like MS, arthritis or Parkinson’s), their access to critical care is reduced depending on how few of eleven activities of daily living they can perform without assistance. This includes dressing, bathing, eating, walking, getting in and out of bed, using the telephone, going shopping, preparing meals, doing housework, taking medication, or handling their finances. That is disability discrimination, pure and simple.

The Ontario Government’s pervasive secrecy over its critical care triage plans has made many people with disabilities terrified, angry and distrustful. The parts of the Ontario critical care triage plan that have leaked to the public make that fear and distrust justified.

The public has a right to know what the Government is planning or considering for critical care triage. We ask you to make those critical care triage plans, draft plans, not-yet-approved plans, and options all public now, such as the following:

1. Please make public the current version of the Ontario critical care triage protocol that has been sent to Ontario hospitals. The Government has never made it public. In contrast, we publicly posted the January 13, 2021 Critical Care Triage Protocol, which was leaked. Please advise if it has been altered since January 13, 2021, or if a more recent version has been sent to hospitals.

2. The April 26, 2021 Globe and Mail included a report by Jeff Gray, confirming that a second critical care triage protocol has also been developed. That report states:

“The other protocol is referred to as the “Critical Care Triage Protocol.” According to a document summarizing it and obtained by The Globe and Mail, it is largely the same, but assumes that cabinet issues an executive order overriding the province’s Health Care Consent Act and allowing existing ICU patients to be disconnected from life support without consent.”

Please give us a copy of that second critical care triage protocol i.e. one that is meant to be used if the Cabinet or Legislature were to suspend the operation of the Health Care Consent Act (even if that second protocol is a draft or has not yet been approved). That second protocol would apply if the Government tried to give doctors the power to unilaterally take critical care away from a patient who is already receiving it and who does not consent to its withdrawal. We are on record opposing the Government giving any such powers to doctors. We have cautioned that any doctor would do so, or would use the January 13, 2021 Critical Care Triage Protocol at their peril.

3. In a January 23, 2021 webinar to train front-line doctors on how to use the January 13, 2021 Critical Care Triage Protocol, it was suggested that Ontario may have given a direction or draft direction to ambulance crews and related emergency services, and/or would be doing so, on EMTs or other ambulance crews undertaking some form of critical care triage on patients even before they arrive at hospital. In our February 25, 2021 letter to you, we asked (referring to the AODA Alliance’s February 25, 2021 report on Ontario’s critical care triage plans):

“This new report also reveals that instructions may have been given or may be given to Ontario emergency services and EMTs on the possibility of not starting critical care supports in some situations for an emergency patient who needs and wants them, before reaching the hospital, if critical care triage has been directed for Ontario. This would be done so that hospitals don’t feel obligated to continue giving that patient critical care. We ask you to let us know if any such instructions have been given or have been designed or contemplated, by whom and to whom, with and with what authority? If so, we ask you to give us a copy of those instructions, past or present, and any draft instructions being considered.”

Your Government never answered that letter. You also did not answer this question when you were asked in the Legislature during Question Period on April 21, 2021.

Please give us any directions or draft directions that have been sent to any ambulance or emergency services or emergency medical technicians (EMTs), or that are prepared for or are being considered for distribution to them, on the possibility of their taking part in any form of critical care triage on patients before the patient gets to hospital.

4. We understand that in addition to the January 13, 2021 Critical Care Triage Protocol (which applies to adult patients), a different critical care triage protocol was developed for patients under the age of 18. We have never seen it or been consulted on it. We have been told nothing about its contents. Could you please give us any protocol or draft protocol now in circulation or prepared for circulation on critical care triage for patients under age 18?

5. If critical care triage is directed or takes place, will your Government commit to swiftly and daily make public the number of people who are denied critical care, or from whom it is withdrawn without the patient’s consent? The public deserves to know this on an immediate basis, along with the other important COVID-19 statistics that are made public each day.

6. The April 26, 2021 Globe and Mail also reported that some Ontario hospitals have been conducting practice drills or simulations with critical care triage. This is to develop experience and familiarity in case critical care triage becomes necessary. On February 25, 2021, we made public the fact that Ontario hospitals were urged to do so.

Is the Government tracking those simulations? Will you make public the results of these drills or simulations, including the hypothetical cases that are used in these drills. The public has a right to know how consistently or inconsistently critical care triage would be handled, depending on which hospital is doing it. The public also deserves to know who would live and who would die as a result of critical care triage, according to these simulations.

Minister, in the past days, your Government has substantially reconsidered and changed its policy in a number of important areas concerning the COVID-19 pandemic. It is urgent for you to now do the same with Ontario’s plans and protocol for critical care triage, so that Ontario is ready in the event that such triage becomes necessary.

The need for your Government to end its secrecy on this issue of life and death is all the more pressing since the Government’s own advisory Bioethics Table has called for openness. As well, fully six members of that Bioethics Table have publicly criticized your Government’s plans regarding critical care triage. Their voices supplemented the concerns voiced by the Ontario Human Rights Commission.

The Government has left it to one of the critical care triage protocol’s authors to publicly defend the Ontario protocol. Defences offered in its defence are transparently meritless.

That protocol’s explicit disability discrimination, described above, is incorrectly and baldly denied. It was argued in its defence that this is not disability discrimination, since some disabilities are not deprioritized for critical care under it. That is like arguing that an employer who refuses to hire Muslims does not discriminate based on religion, because that employer is nevertheless willing to hire Jews.

In the protocol’s defence, it was argued as well that the protocol can’t be disability discriminatory, because under it, two people with the same disability might not be assessed the same during triage. That argument rests on the bogus idea that the policy must discriminate against all people with disabilities with equal cruelty before it is disability discrimination against any people with disabilities. See further the April 20, 2021 AODA Alliance Update.

We ask you to answer this letter, and to meet with us and others from Ontario’s disability community, in this urgent situation. Neither you nor your Government’s officials who are making decisions in this area have met with us to discuss our concerns, despite our requests.

You have not answered any of our eight earlier letters to you over the past seven months. Those letters detail serious and well-researched objections to disability discrimination in Ontario’s critical care triage plans, including the AODA Alliance’s September 25, 2020 letter, its November 2, 2020 letter, its November 9, 2020 letter, its December 7, 2020 letter, its December 15, 2020 letter, its December 17, 2020 letter, its January 18, 2021 letter and its February 25, 2021 letter to you.

Please stay safe.

Sincerely,

David Lepofsky CM, O. Ont
Chair Accessibility for Ontarians with Disabilities Act Alliance CC:
Premier Doug Ford [email protected]
Helen Angus, Deputy Minister of Health [email protected] Raymond Cho, Minister of Seniors and Accessibility [email protected]
Denise Cole, Deputy Minister for Seniors and Accessibility [email protected]
Mary Bartolomucci, Assistant Deputy Minister for the Accessibility Directorate, [email protected]
Todd Smith, Minister of Children, Community and Social Services [email protected]
Janet Menard, Deputy Minister, Ministry of Children, Community and Social Services [email protected]
Ena Chadha, Chief Commissioner of the Ontario Human Rights Commission [email protected]
Robert Lattanzio, Executive Director, ARCH Disability Law Centre [email protected]

Globe and Mail April 26, 2021

Originally posted at https://www.theglobeandmail.com/canada/article-ontario-doctors-prepare-for-worst-case-covid-19-triage-decisions/?cmpid=rss&utm_source=dlvr.it&utm_medium=twitter News Ontario doctors prepare for worst-case triage calls
By JEFF GRAY
Staff
Ontario doctors have been taking part in virtual training sessions on the province’s worst-case scenario COVID-19 emergency triage protocol, using role-play to practise telling families their loved ones are ineligible for life-support.

The triage protocol would employ a series of metrics to score incoming patients on their likelihood of survival in 12 months. If COVID-19’s growth outstrips all current efforts to expand the intensive-care system, transfer patients to other hospitals across the province and draft in extra staff, the protocol would reserve scarce ICU beds for those deemed more likely to survive.

The province’s rapidly swelling intensive care units were home to a record 851 COVID-19 patients as of Sunday and some hospitals were still familiarizing their staff with the complex triage system that could be enacted.

Erin O’Connor, deputy medical director of the emergency departments in the University Health Network, which includes Toronto General, Toronto Western and Princess Margaret hospitals, said her simulation team has been running role-play training sessions on the protocol since the second wave. But now, she is fielding calls from other hospitals that are trying to prepare for the worst.

“Honestly, it’s terrifying for all of us,” Dr. O’Connor said. “And we are all just trying to brace ourselves and prepare ourselves as well as we possibly can to deliver the best care we can in a situation where we don’t have unlimited resources.”

Ontario has ramped down all non-emergency surgeries and procedures to try to accommodate the current COVID-19 surge.

It is trying to encourage the shifting of elderly patients from hospitals into empty spaces in longterm care. It has also been moving hundreds of critical-care patients a week – by helicopter, ambulance and even a retrofitted bus – from packed hotspot hospitals in the Greater Toronto Area to ICUs as far away as Kingston.

In addition to military-style tents set up alongside hospitals, the province is installing makeshift ICUs in operating rooms and recovery rooms. And ICU nurses are working with teams of redeployed, less-experienced staff to oversee more patients, said Chris Simpson, executive vice-president of Ontario Health, the government agency that oversees the health system, and a Kingston cardiologist.

Modelling from the province’s COVID-19 Science Advisory table predicted a peak of at least 1,500 virus cases in ICUs by the first week of May, and possibly as many as 2,000. That’s as many ICU beds as Ontario has now in total, filled with more than 800 COVID-19 patients and about 1,200 non-COVID-19 patients.

Theoretically, with the existing ICU system running all out, it could accommodate a maximum of 2,300. On top of that, Ontario Health has told hospitals to find staff and space for more than 1,000 additional beds, many of which would be ICU-like beds operated with fewer staff.

If the system can manage all that expansion, and do it fast enough, officials hope the worst can be avoided. But nobody knows if this is doable – or how long it could be sustained. And everyone agrees that at these numbers, the quality of care would be severely compromised.

Most agree it already is.

“I think that’s kind of a stretch goal where we think we could get,” Dr. Simpson said, adding that every corner of every hospital is being scoured for space and staff. “If it does come to using the triage tool, I think we need to be able to say we have absolutely maximized and done everything we possibly could.”

If the system as a whole, or a hospital or a regional group of hospitals, completely runs out of space but faces a queue of critically ill patients – whether they are suffering from COVID-19, or car collisions, or heart attacks – drastic decisions may need to be made.

There are actually two protocols, neither of which has been formally made public. Ontario Health Minister Christine Elliott has said repeatedly that no protocols have been approved and refused to release them. Disability rights groups and the Ontario Human Rights Commission have raised concerns about potential discrimination against the disabled.

According to a leaked copy of one protocol, known as the “Emergency Standard of Care” and circulated to hospitals in January, two doctors would evaluate each incoming patient, using a set of criteria to determine their chances of survival. A webbased calculator may also be used to plug in the data about a patient’s condition. Ties could see a randomizer website make the final call.

It would be phased in: At Level 1 triage, all patients with more than an 80-per-cent chance of death after 12 months would be “deprioritized” for ICU beds and instead receive palliative care. At Level 2, the cutoff becomes a more than 50-per-cent chance of death at one year. At Level 3, it moves to just 30 per cent.

According to the leaked copy of the Emergency Standard of Care, it is up to the Ontario-wide Critical Care COVID-19 Command Centre to declare when to use it.

The other protocol is referred to as the “Critical Care Triage Protocol.” According to a document summarizing it and obtained by The Globe and Mail, it is largely the same, but assumes that cabinet issues an executive order overriding the province’s Health Care Consent Act and allowing existing ICU patients to be disconnected from life support without consent. Such an order, some doctors say, would save more lives, as those in ICUs with little hope of survival could be removed to make way for new patients with better chances.

Whether the system can surge enough to avoid either scenario, doctors say, also depends on how quickly the province’s stay-athome order and retail and restaurant shutdowns – and its hotzone vaccination push – can start to push down infection numbers.

But ICU numbers, which lag those daily new infection counts, are expected to keep rising in the near term. Plus, those who end up in ICU with COVID-19 are now staying longer.

Ontario registered 3,947 new infections on Sunday, pushing the seven-day average down slightly to 4,051 – below the more recent worst-case projections.

There were 24 deaths.

Whatever happens, many doctors warn the system is already triaging by another name.

Everything from cancer procedures to heart surgeries are being postponed. Plus, crowded, understaffed makeshift ICUs will result in more deaths for both COVID-19 and non-COVID-19 patients, said James Downar, a specialist in critical care at the Ottawa Hospital who was involved in drafting the triage protocols. Whether it makes sense depends on how long the surge lasts, he said.

“The question isn’t, ‘When do we start triage?’ It’s ‘When do we change the way we are triaging?’ ” he said.

Already, reports of the surge’s collateral damage are surfacing.

Nir Lipsman, a neurosurgeon at Toronto’s Sunnybrook Hospital, posted on Twitter last week that a young patient with head trauma was left without an operating-room slot as the hospital was jammed with COVID-19 patients.

After rearranging some patients and bringing in extra nurses, his team was able to make this surgery happen.

“This is the domino effect, the downstream effect, of this wave that we are experiencing,” Dr.

Lipsman said.




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As The Ford Government Back-Pedals and Scrambles to Re-Invent Its Response to the COVID-19 Crisis, Will It Make Public and Fix Its Disability-Discriminatory Critical Care Triage Plans?


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

April 22, 2021

SUMMARY

The Ford Government appears shell-shocked, as it flip-flops, back-tracks and scrambles to respond to the imminent threat that Ontario will run out of space and staff to deliver life-saving critical care to all patients who need it.
Here are yet more recent developments in the non-partisan campaign to try to ensure that people with disabilities will not face disability discrimination in access to life-saving critical care, if that care is rationed or triaged. Regrettably, the Government has shown no willingness to lift the fog of secrecy over its critical care triage plans, to talk directly to disability advocates and organizations about it, or to fix the serious problems with its critical care triage protocol and plans. 1. The Latest Developments in a Nutshell

1. On Tuesday night, April 20, 2021, a very successful online virtual public forum was held to discuss the critical care triage issue as it affects people with disabilities. Key speakers were AODA Alliance Chair David Lepofsky and ARCH Disability Law Centre Executive Director Robert Lattanzio. We are thrilled that an impressive 280 people took part. They got action tips on how to help with our fight against the danger of disability discrimination in critical care triage, if triage takes place.
We all wish there was more time to take all the questions that so many wanted to ask. A huge thank you goes to all who helped organize this event, and all who took the time to attend it.
2. The disability objections to Ontarios controversial critical care triage protocol and plans were raised on Tuesday, April 20 and Wednesday April 21, 2021 in the Ontario Legislatures Question Period. Below, you can read these exchanges and our reflections on them.

3. On Wednesday, April 21, 2022, Ontario New Democratic Party disabilities critic Joel Harden held a virtual Queens Park news conference, focusing on disability objections to Ontarios critical care triage protocol and plans. The speakers that MPP Harden invited to make remarks included AODA Alliance Chair David Lepofsky, ARCH Disability Law Centre legal counsel Mariam Shanouda, and Disability Justice Network of Ontario co-founder Sarah Jama. The AODA Alliance appreciated the opportunity to contribute to this event. As a non-partisan coalition, we take part in news conferences convened by any of the political parties to which we are invited, where the event provides a helpful platform to raise our issues.
Arising out of this well-attended news conference, the NDP issued a news release on April 21, 2022, set out below. It includes a quotation from AODA Alliance Chair David Lepofsky setting out our position. It includes quotations from the other speakers as well.
4. The influential publication QP Briefing ran a strong article on April 21, 2021, arising from that days news conference. We set it out below.
5. The April 22, 2021 online edition of the Ottawa Citizen includes a guest column on the triage issue by NDP disabilities critic Joel Harden. We also provide it for you in this Update.
2. Yet More Reflections on Ongoing Ford Government Failure to Respond to Our Disability Concerns with Its Critical Care Triage Protocol and Plans

1. We have gotten more and more feedback from people with disabilities about the critical care triage disability objections. We keep hearing that people are frightened and angry. As if the COVID-19 pandemic was not bad enough, this issue makes them feel even more vulnerable and at risk.
At the same time, the message we all hear from the public around Ontario over the past six days has been louder than ever: The Ford Governments response to the COVID-19 pandemic needs a major re-think, and fast. Weve added that this rapid re-think needs to include Ontarios critical care triage protocol and plans.
2. In the Legislatures Question Period this week, the Ford Government offered the public evasions and contradictions on this issue.
On Tuesday, April 20, 2021, Health Minister Christine Elliott made a statement that many understood as denying that there even is an Ontario critical care triage protocol. She stated:
I think one thing is really important, Speaker, and I would say to the member opposite, through you, that the speaker is alleging that there is a triage protocol in place in Ontario. There is not; there is not.
This, of course, would contradict the January 13, 2021 Critical Care Triage Protocol, which has been posted on the AODA Alliance website for three months. It would contradict the January 23, 2021 online webinar provided by Critical Care Services Ontario which tries to convince doctors to ready themselves to use that protocol if it becomes necessary. It would contradict the interview on the April 21, 2021 CBC Ottawa Morning radio program in which Dr. James Downar, the author or co-author of that protocol, defended it.
On Twitter, a number of members of the public angrily denounced the Ministers statement. The next day, April 21, 2021, Health Minister Christine Elliott acknowledged that there is a critical care triage protocol, but said it has not yet gone into operation. She stated:
I can certainly advise the member that no triage protocol has been activated or approved by the government of Ontario.
There have been discussions. I understand that there were a number of disability groups that were concerned with respect to a previous draft that was prepared earlier this year. That was then reviewed with the human rights commission. There have been a number of discussions about modifications to it. But nothing has been activated, nothing has been approved by this government.
3. The Health Minister said that there were objections from disability groups to an earlier draft of the critical care triage protocol. That is true. However, we have repeatedly made public that we also object to the most recent version of it, the one issued to hospitals dated January 13, 2021.
4. Also in the Legislature, the Ford Government refused to answer a clear, simple and direct question on what instructions regarding critical care triage have been given to ambulance crews. In Question Period on April 21, 2021, MPP Joel Harden asked Health Minister Elliott:
Speaker, I want to ask the minister, who is very well versed in these issues: What instructions have been sent out and drafted to emergency medical technicians, ambulance services or health professionals about who will live and who will die in our ICUs?
The Ministers response did not answer this important question. The AODA Alliance asked the Health Minister the same thing two months ago in our February 25, 2021 letter to her. The Government has never answered that question or that letter.
In Health Minister Elliotts April 21, 2021 answer in Question Period, an impression may be created that the Government has been consulting on the critical care triage protocol. No one has consulted us on the January 13, 2021 Critical Care Triage Protocol.
5. In its defence, the Ford Government said it is now reaching out to others outside Ontario, to see if they can bring more doctors, nurses and other needed health professionals to help out in Ontarios intensive care units. This is a much-needed measure. It could avert the need for any critical care triage.
However, we must ask why the Ford Government was not doing this weeks and months ago, when it was given ample early warning that Ontario was at risk of critical care overload. Had it done so, we would not be facing the imminent danger we now are confronting. The Ford Government could have had in place detailed emergency plans to shuttle health care professionals to Ontario, with prior clearances from the relevant licensing bodies so they can work here in this emergency. This further illustrates Ontarios failure to properly prepare.
For more information on these issues, visit the AODA Alliance websites health care page. MORE DETAILS

Ontario Hansard April 20, 2021
Question Period
COVID-19 RESPONSE
Ms. Sara Singh:My question is for the Premier. For months, experts including members of the Premiers own science table have been sounding the alarm about dangerously high ICU levels, and today we learned that there are over 760 people fighting for their lives in Ontario ICUs, Speaker.

But the Premier failed to act. They failed to implement paid sick days. They failed to vaccinate workers in hot spots, and now ICUs in communities like Brampton are overflowing. Pediatric hospitals are sacrificing their beds. Patients are being transferred to hospitals around the province outside of their communities, and doctors and nurses are being put in the horrific position of having to make decisions on who will receive life-saving supports and who will not.
Speaker, whywith all of the evidence in front of this government; all of the warnings from their own science tables and medical expertsdoes this government continue to ignore the crisis in our ICUs? The Speaker (Hon. Ted Arnott):Minister of Health.
Hon. Christine Elliott:We have been listening to the experts all along. We have been listening to their evidence. I think one thing is really important, Speaker, and I would say to the member opposite, through you, that the speaker is alleging that there is a triage protocol in place in Ontario. There is not; there is not.
What we are doing is building capacity in our hospitals. We are making sure there are two aspects to what we need to deal with here. We need to blunt the transmission of COVID-19 in communities, as well as, right now, we need to build capacity in our hospitals, which are we are doing.
We are in contact with the CEOs of the hospitals on virtually a daily basis. They are working very hard to create spaces.
We are creating capacity so that everyone in Ontario who needs to be admitted to hospital and needs to be in an intensive care bed will have a bed available for them.

The Speaker (Hon. Ted Arnott):Supplementary?
Ms. Sara Singh:Mr. Speaker, with all due respect to the Minister of Health, that response shows us how out of touch with reality this minister is. Doctors are sounding the alarm bells and this government continues to ignore their pleas for help. The government is following a pattern of denying the problem and acting too late.
Now the government is begging other provinces for help, but refusing the federal governments assistance and the assistance of the Red Cross. Speaker, health care systems in other provinces are also fighting COVID-19. They need their health care workers just as much as we do. It was this Premiers responsibility and this Minister of Healths responsibility to help protect people here in Ontario, and they failed to do that at every step of the pandemic.
This is a national and global failure and it is upsetting and heartbreaking to know that they could have acted and they chose not to. With months to plan for this crisis, why did this Premier fail to address the issues causing ICU capacity to rise, and why does the government think its another governments responsibility to come and clean up their mess? Interjections.
The Speaker (Hon. Ted Arnott):Ill ask members to please take their seats and allow the Minister of Health to reply.
Hon. Christine Elliott:Again, through you, Mr. Speaker, I would say to the member opposite that what youre suggesting is simply not the case. Since the beginning of this pandemic, we have been working hard to make sure that we have both the health human resources Ms. Sara Singh:Why are people dying?
Hon. Christine Elliott:and the physical capacity in order to deal with whats been happening. We have created Interjection.
Hon. Christine Elliott:I dont know if the member opposite really wants to hear me, shes
The Speaker (Hon. Ted Arnott):Im going to ask the Minister of Health to take her seat. Interjections.
The Speaker (Hon. Ted Arnott):Im going to ask the member for Brampton Centre to come to order. Im going to ask the government House leader to come to order. Interjection.
The Speaker (Hon. Ted Arnott):Always innocent.
Im going to recognize the Minister of Health to conclude her response.
Hon. Christine Elliott:Thank you, Speaker. To continue, since the beginning of this pandemic, we have created over 3,100 new hospital beds, which is the equivalent of six new community hospitals. We have also added 14% to intensive care capacity, which is significant in the context of this pandemic.
We have also added resources in order to be able to deal with the health human resources that we need. We have allowed for the deployment of people from one sector to another.
Finally, I would say with respect to whats happening with other provinces and other organizations coming in to help us, were very grateful for the help thats being offered by the other provinces and were very grateful to the federal government for their offer of assistance from the Red Cross as well. We know that we need help right now. We have the physical capacity. We need some more health human resources and we are using those resources to make sure everyone who needs help will get help in our hospitals. Ontario Hansard April 21, 2021
Question Period
COVID-19 RESPONSE
Mr. Joel Harden:My question is to the Minister of Health. As many people have already raised this morning, our ICUs are near the breaking point. Were getting close to 100 patients now being treated in our ICUs, but despite this fact, the government has refused to make public its plans for critical care triage in those ICUs. We dont know. People with disabilities and their loved ones and advocacy organizations still dont know what has been negotiated in secret and what actually will happen when those life-and-death decisions take place but, at home, Dr. David Neilipovitz, the ICU director at the Ottawa Hospital told CBC News, It would be naïve for us to think that triage or changes in the standard of care have not already come about. Lets think about that.
Yesterday, the minister rose in this House and said there is no clinical triage protocol, but we know that hospitals received one on January 13. We also know that a training was done for medical professionals on YouTube on the 23rd of January.
Speaker, I want to ask the minister, who is very well versed in these issues: What instructions have been sent out and drafted to emergency medical technicians, ambulance services or health professionals about who will live and who will die in our ICUs? The Speaker (Hon. Ted Arnott):Minister of health.
Hon. Christine Elliott:I can certainly advise the member that no triage protocol has been activated or approved by the government of Ontario.
There have been discussions. I understand that there were a number of disability groups that were concerned with respect to a previous draft that was prepared earlier this year. That was then reviewed with the human rights commission. There have been a number of discussions about modifications to it. But nothing has been activated, nothing has been approved by this government.
What we are doing instead is to create the capacity so that we can care for all the patients that come into our hospital, whether theyre COVID patients or emergency patients that come in otherwise. We have created over 3,100 beds since this pandemic began, increased our intensive care capacity by 14%.
We are looking at bringing in other health professionals from other provinces and other countries so that, notwithstanding having the creation of those spaces, we will also have the health human resources in order to be able to operate them safely, carefully and professionally. The Speaker (Hon. Ted Arnott):The supplementary question.
Mr. Joel Harden:Earlier today, I was joined by disability rights leaders for a media conference, all of whom are calling upon this government to make public its plans for critical care triage. Speaker, I know this minister served as Patient Ombudsperson for this province for years and knows full well that every patient, physiotypical, neurotypical or not, has a right to their care at the point of service. But the minister also should know that hospitals got a critical triage protocol on January 13, that a training has been conducted. So I must admit my extreme frustration that today, when our ICUs are nearing capacity, we are still hearing, There are no plans.
Speaker, let me say very clearly for this House, I didnt know, at this point: not an acceptable answer. I was just following orders, at this point: not an acceptable answer. Please forgive me to disabled patients and their loved ones: not an acceptable answer.
Will you make sure that people with disabilities are not discriminated against in the ICUs: yes or no?
The Speaker (Hon. Ted Arnott):Again, Ill ask the members to make their comments through the Chair. The Minister of Health to respond.
Hon. Christine Elliott:The rights of people with disabilities has been one of my strongest passions since I got to this place 15 years ago, and I dont need to take any instructions from anybody Ms. Andrea Horwath:Ha!
Hon. Christine Elliott:including the leader of the official opposition, about this issue. I have always stood up for the rights of people with disabilities Interjections.
The Speaker (Hon. Ted Arnott):Order. Opposition, come to order. The member for NorthumberlandPeterborough South, come to order. The Minister of Health, please reply.

Hon. Christine Elliott:The rights of people with disabilities have been one of the issues that we have cared about and dealt with as part of this entire pandemic. The rights of people with disabilities are equally as important as the rights of anybody else. That is something that Ive always stood by, that
I always will stand by. I can assure the member opposite that no triage protocol has been approved. A draft was circulated in January. That was not approved by this government. It was something that had been discussed. But I understand that the rights of people with disabilities have been brought forward. I asked them Interjections.
The Speaker (Hon. Ted Arnott):The member for Ottawa Centre, come to order. The member for Hamilton WestAncasterDundas, come to order. The minister, please conclude her response.
Hon. Christine Elliott:I asked that this issue be dealt with, with the people with disabilities groups, as well as with the Ontario Human Rights Commission. There have been numerous discussions, but nothing has been activated yet, and I can assure you nothing has been approved at this point. We are working to make sure The Speaker (Hon. Ted Arnott):Thank you. The next question.

QP Briefing April 21, 2021

Originally posted at https://www.qpbriefing.com/2021/04/21/solicitor-general-brushes-off-disability-advocate-concerns-about-triage-protocol/ SOLICITOR GENERAL BRUSHES OFF DISABILITY ADVOCATE CONCERNS ABOUT TRIAGE PROTOCOL
Home Health And COVID-19 Solicitor General Brushes Off Disability Advocate Concerns About Triage Protocol Solicitor general brushes off disability advocate concerns about triage protocol
Asked about concerns raised by disability advocates for months that the provincial triage guidelines discriminate against them, Ontario’s solicitor general got upset.

“There is no triage protocol being used,” Sylvia Jones said, cutting off the question from QP Briefing. “I am very frustrated that you continue to suggest that there is a triage protocol in place in the province of Ontario in our hospitals. Talk to the hospital CEOs, talk to the minister of health. It is not accurate.”

Jones and Health Minister Christine Elliott said the government has not approved a plan for deciding who lives and who dies should Ontario intensive care units run out of life-saving equipment.

But while it has not been officially triggered, the preparation for the nightmare scenario is real.

Hospitals received training on draft guidelines, which leaked in January, and are preparing to use them.

Doctors and nurses have told reporters that due to rising case counts in the third wave of COVID-19, triage decisions could be days away. Some say that while the protocol has not been implemented, decisions to ration or triage care are already happening, including the cancellation of scheduled surgeries.

And advocates for people with disabilities say they worry that if and when the time comes, they will be seen as less deserving of care than someone without disabilities, because of two key parts of the protocol.

One is the inclusion of the “clinical frailty scale,” which outlines how dependent people are on others to live their lives.

It “asks questions like, can you get dressed yourself, without assistance? Can you go grocery shopping without assistance? Can you use a telephone without assistance?” said Mariam Shanouda, a lawyer with Toronto’s ARCH Disability Law Centre. “And if you answer no, I can’t do any of these things without assistance, then you are less likely to access critical care. This is disability discrimination in a nutshell.”

The other major issue is that doctors are asked to estimate patients’ likelihood of surviving the next 12 months. That timeline is too long, advocates say, and could force medical staff to “guesstimate”

“Guessing is not science,” said David Lepofsky, chair of the AODA Alliance. “And it doesn’t become science because the person doing it, or who’s being mandated to do it, has a white coat on and a stethoscope.”

Another issue is that advocates don’t know whether the protocol from January is unchanged, or whether a new version is being prepared. Lepofsky said the government refuses to answer any of his calls.

“The solution is for the government to immediately make public their step-by-step plan for rolling this out, which they obviously have, so we can know what they’re planning to do,” he said.

The Ministry of Health should speak directly to disability advocacy groups like his, “so we can have input into this, rather than having to communicate with the human shields behind whom they’re hiding, such as the Bioethics Table,” he said.

And each hospital that’s done a triaging drill should make the results of that drill public, “so the public can know how much these simulations for triage might vary, depending on which hospital you happen to go to,” Lepofsky said.

Opposition leaders also called for transparency.

Green Leader Mike Schreiner said he shares the concerns of disability advocates, and argued the government should release the guidelines publicly.

He also noted that ODSP payments have not gone up recently, despite the fact that “Ontarians with disabilities have borne a disproportionate burden in this pandemic.”

Liberal health critic John Fraser said Ontario is “dangerously close to asking clinicians to decide who gets care and who doesn’t. The government needs to be open and transparent about the status of the triage protocol. I think the disability advocates have a legitimate concern. The government should have been listening from the start and needs to engage with them now.”

In question period on Wednesday, Joel Harden, the NDP critic for accessibility and persons with disabilities, quoted Dr. David Neilipovitz, the ICU director at the Ottawa Hospital, who told CBC: “‘It would be naive for us to think that triage or changes in the standard of care have not already come about.’ Lets think about that,” he said.

“Yesterday, the minister rose in this house and said there is no clinical triage protocol, but we know that hospitals received one on January 13. We also know that a training was done for medical professionals on YouTube on the 23rd of January. Speaker, I want to ask the minister, who is very well versed in these issues: what instructions have been sent out and drafted to emergency medical technicians, ambulance services or health professionals about who will live and who will die in our ICUs?”

Elliott repeated that there is no official triage protocol yet.

“There have been discussions,” she said. “I understand that there were a number of disability groups that were concerned with respect to a previous draft that was prepared earlier this year. That was then reviewed with the human rights commission. There have been a number of discussions about modifications to it. But nothing has been activated, nothing has been approved by this government.”

It was indeed reviewed with the Ontario Human Rights Commission in December, but the organization still disapproves. Chief Commissioner Ena Chadha sent a letter to Elliott in March outlining concerns with the draft protocol and called on the government to publicly release it.

Harden said “there are no plans” is “not an acceptable answer.”

Elliott disagreed.

“The rights of people with disabilities has been one of my strongest passions since I got to this place 15 years ago,” she said, “and I dont need to take any instructions from anybody”

NDP Leader Andrea Horwath interjected, “Ha!”

“including the leader of the Official Opposition, about this issue,” Elliott finished.

Ottawa Citizen Online April 22, 2021

Originally posted at https://ottawacitizen.com/opinion/harden-ontarios-covid-triage-protocol-must-respect-rights-of-the-disabled Opinion Columnists

Harden: Ontarios COVID triage protocol must respect rights of the disabled

Just over a year ago, 200+ community organizations urged the Ford government to remove disability discrimination from the triage guidance. The response so far: silence.

Joel Harden

The Children’s Hospital of Eastern Ontario is accepting adult critical care patients due to the growing severity of the COVID-19 crisis. PHOTO BY ERROL MCGIHON /Errol McGihon
These are perilous times in Ontario. On April 16, 2021, a record-breaking 4,812 new COVID-19 cases were recorded.

At the moment, more than 750 patients are being treated in Ontarios ICUs. For the first time in its 47-year history, the Childrens Hospital of Eastern Ontario is accepting adult COVID-19 patients who require critical care.

There is a real possibility that by the end of the month, hospitals will have to ration or triage critical care due to surging COVID case counts. Triage refers to how hospitals will decide who gets life-saving care if ICUs are overwhelmed with COVID patients and they run out of beds.

Along with disability and human rights leaders, I am deeply concerned that the Doug Ford governments current clinical triage protocol includes disability discrimination, and hasnt been developed with adequate consultation.

Whats wrong with the triage protocol that was circulated to hospitals on Jan. 13, 2021? Firstly, it includes a clinical frailty scale, meaning that a patient over the age of 65 with a progressive disease (Alzheimers, Muscular Dystrophy etc.) will be evaluated based on how they can perform 11 different activities of daily living without assistance. This is blatantly discriminatory against people with disabilities, millions of whom require varying degrees of assistance to live their fullest lives.

Secondly, it includes criteria that assess the patients likelihood of mortality one year from their admission to hospital. Even ICU doctors have conceded that such assessments are guesstimates rather than an exact science. This leaves the door open to subjective judgments about a persons quality of life that could discriminate against people with disabilities, as opposed to a shorter-term assessment of mortality.

No one is suggesting that Ontario shouldnt have a triage protocol in place if ICUs are filled to maximum capacity. What we are saying is that the protocol must respect human rights and the rule of law. It also needs to be discussed openly and transparently, but this government has taken the opposite approach.

Members of the governments own bioethics table have criticized the secrecy with which the government has been handling its approach to clinical triage. Noting that the process must be informed, transparent, inclusive, reasonable and subject to revision in light of new information or legitimate concerns or claims, they believe that Ontario has failed to meet these requirements.

News media have also reported that the Ford government is considering suspending parts of the Health Care Consent Act (HCCA), which requires doctors to obtain consent from a patient or their substitute decision maker before they withdraw critical care.

It is unacceptable for the government to make life-and-death decisions by a secret memo. If they are considering suspending the HCCA, they must make the details public and have a proper debate in the legislature.

Just over a year ago, 200+ community organizations wrote to the Ford government urging it to remove disability discrimination from the provinces triage protocol. For more than a year, the government has been aware of these concerns and had ample time to consult with disability and human rights leaders in developing its clinical triage protocol.

How has the Ford government responded? With complete silence. It has ignored direct appeals from disability groups, the Ontario Human Rights Commission and the opposition, all of whom have expressed concerns with the Jan. 13 emergency standard of care triage protocol.

What message does this send to the 2.6 million people with disabilities who live in Ontario? People with disabilities are more likely to get COVID-19, and to be seriously impacted by the virus. This government must assure them that they wont face any discrimination in the awful event that triage becomes necessary.

Its time to stop the secrecy surrounding critical care triage. Its time for the Ford government to remove disability discrimination from its clinical triage protocol.

Joel Harden is the NDP MPP for Ottawa Centre and opposition critic, accessibility and persons with disabilities.

New Democratic Party April 21, 2021 News Release

NDP MPP Joel Harden, disability rights advocates call on Ford to remove disability discrimination from triage protocol
QUEENS PARK MPP Joel Harden (Ottawa Centre), the NDPs critic for Accessibility and Persons with Disabilities, called on the Ford government to withdraw disability discrimination from Ontarios clinical triage protocol and immediately hold a public consultation on how care will be triaged if ICUs become too overwhelmed to fully treat everyone.
Harden was joined at a Wednesday morning press conference by David Lepofsky, Chair of the AODA Alliance, Sarah Jama, Co-founder of the Disability Justice Network of Ontario, and Mariam Shanouda, Staff Lawyer at ARCH Disability Law Centre, all of whom are expressing deep concerns about the protocol and the secrecy surrounding it.
We should never have gotten to the point where critical care triage became a possibility, but the Ford governments choice to put money and politics ahead of public health has brought ICUs to the breaking point, said Harden. The government must remove disability discrimination from its triage protocol, and assure people with disabilities that they wont be deprioritized for life-saving critical care.
The Ford government continues to ignore human rights concerns raised by disability rights leaders, and the Ontario Human Rights Commission about its approach to clinical triage. They have not held open consultations, and it was disability organizations and the opposition, not the government, that made public the January 13, 2021 triage protocol which was sent to hospitals.
This entire process has been cloaked in secrecy, said Harden. Thats wrong, and its time for the government to stop making life-and-death decisions behind closed doors. Quotes:
David Lepofsky, Chair, AODA Alliance
“Our non-partisan grassroots coalition agrees that Ontario must be prepared for the possibility of critical care triage, but Ontarios plan must include a triage protocol, mandated by the Legislature, that does not violate the Charter of Rights or the Ontario Human Rights Code by discriminating against people with disabilities or denying them due process. They have already disproportionately suffered the hardships of the COVID-19 pandemic.

Sarah Jama, Co-founder, Disability Justice Network of Ontario
We are in a time of deep crisis, and need to offer paid sick days and increase social assistance rates for community members without work from home jobs, or a safety net. But rather than make these preventative policy decisions, our government has created conditions where doctors must rank who gets to live and who gets to die.

Mariam Shanouda, Staff Lawyer, ARCH Disability Law Centre
“Health care, including critical care during a pandemic, must be available free from unlawful discrimination. This is a life and death non-partisan issue. The choice must not be whether we have no triage plan or one that discriminates. And lets be clear, the current plan is discriminatory and will disproportionately impact persons with disabilities who have already disproportionately experienced devastating consequences from this pandemic.”




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As The Ford Government Back-Pedals and Scrambles to Re-Invent Its Response to the COVID-19 Crisis, Will It Make Public and Fix Its Disability-Discriminatory Critical Care Triage Plans?


Accessibility for Ontarians with Disabilities Act Alliance Update

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

Web: www.aodaalliance.org Email: [email protected] Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

As The Ford Government Back-Pedals and Scrambles to Re-Invent Its Response to the COVID-19 Crisis, Will It Make Public and Fix Its Disability-Discriminatory Critical Care Triage Plans?

April 22, 2021

            SUMMARY

The Ford Government appears shell-shocked, as it flip-flops, back-tracks and scrambles to respond to the imminent threat that Ontario will run out of space and staff to deliver life-saving critical care to all patients who need it.

Here are yet more recent developments in the non-partisan campaign to try to ensure that people with disabilities will not face disability discrimination in access to life-saving critical care, if that care is rationed or “triaged.” Regrettably, the Government has shown no willingness to lift the fog of secrecy over its critical care triage plans, to talk directly to disability advocates and organizations about it, or to fix the serious problems with its critical care triage protocol and plans.

1. The Latest Developments in a Nutshell

  1. On Tuesday night, April 20, 2021, a very successful online virtual public forum was held to discuss the critical care triage issue as it affects people with disabilities. Key speakers were AODA Alliance Chair David Lepofsky and ARCH Disability Law Centre Executive Director Robert Lattanzio. We are thrilled that an impressive 280 people took part. They got action tips on how to help with our fight against the danger of disability discrimination in critical care triage, if triage takes place.

We all wish there was more time to take all the questions that so many wanted to ask. A huge thank you goes to all who helped organize this event, and all who took the time to attend it.

  1. The disability objections to Ontario’s controversial critical care triage protocol and plans were raised on Tuesday, April 20 and Wednesday April 21, 2021 in the Ontario Legislature’s Question Period. Below, you can read these exchanges and our reflections on them.
  1. On Wednesday, April 21, 2022, Ontario New Democratic Party disabilities critic Joel Harden held a virtual Queen’s Park news conference, focusing on disability objections to Ontario’s critical care triage protocol and plans. The speakers that MPP Harden invited to make remarks included AODA Alliance Chair David Lepofsky, ARCH Disability Law Centre legal counsel Mariam Shanouda, and Disability Justice Network of Ontario co-founder Sarah Jama. The AODA Alliance appreciated the opportunity to contribute to this event. As a non-partisan coalition, we take part in news conferences convened by any of the political parties to which we are invited, where the event provides a helpful platform to raise our issues.

Arising out of this well-attended news conference, the NDP issued a news release on April 21, 2022, set out below. It includes a quotation from AODA Alliance Chair David Lepofsky setting out our position. It includes quotations from the other speakers as well.

  1. The influential publication QP Briefing ran a strong article on April 21, 2021, arising from that day’s news conference. We set it out below.
  2. The April 22, 2021 online edition of the Ottawa Citizen includes a guest column on the triage issue by NDP disabilities critic Joel Harden. We also provide it for you in this Update.

2. Yet More Reflections on Ongoing Ford Government Failure to Respond to Our Disability Concerns with Its Critical Care Triage Protocol and Plans

  1. We have gotten more and more feedback from people with disabilities about the critical care triage disability objections. We keep hearing that people are frightened and angry. As if the COVID-19 pandemic was not bad enough, this issue makes them feel even more vulnerable and at risk.

At the same time, the message we all hear from the public around Ontario over the past six days has been louder than ever: The Ford Government’s response to the COVID-19 pandemic needs a major re-think, and fast. We’ve added that this rapid re-think needs to include Ontario’s critical care triage protocol and plans.

  1. In the Legislature’s Question Period this week, the Ford Government offered the public evasions and contradictions on this issue.

On Tuesday, April 20, 2021, Health Minister Christine Elliott made a statement that many understood as denying that there even is an Ontario critical care triage protocol.  She stated:

“I think one thing is really important, Speaker, and I would say to the member opposite, through you, that the speaker is alleging that there is a triage protocol in place in Ontario. There is not; there is not.”

This, of course, would contradict the January 13, 2021 Critical Care Triage Protocol, which has been posted on the AODA Alliance website for three months. It would contradict the January 23, 2021 online webinar provided by Critical Care Services Ontario which tries to convince doctors to ready themselves to use that protocol if it becomes necessary. It would contradict the interview on the April 21, 2021 CBC Ottawa Morning radio program in which Dr. James Downar, the author or co-author of that protocol, defended it.

On Twitter, a number of members of the public angrily denounced the Minister’s statement. The next day, April 21, 2021, Health Minister Christine Elliott acknowledged that there is a critical care triage protocol, but said it has not yet gone into operation. She stated:

“I can certainly advise the member that no triage protocol has been activated or approved by the government of Ontario.

There have been discussions. I understand that there were a number of disability groups that were concerned with respect to a previous draft that was prepared earlier this year. That was then reviewed with the human rights commission. There have been a number of discussions about modifications to it. But nothing has been activated, nothing has been approved by this government.”

  1. The Health Minister said that there were objections from disability groups to an earlier draft of the critical care triage protocol. That is true. However, we have repeatedly made public that we also object to the most recent version of it, the one issued to hospitals dated January 13, 2021.
  2. Also in the Legislature, the Ford Government refused to answer a clear, simple and direct question on what instructions regarding critical care triage have been given to ambulance crews. In Question Period on April 21, 2021, MPP Joel Harden asked Health Minister Elliott:

“Speaker, I want to ask the minister, who is very well versed in these issues: What instructions have been sent out and drafted to emergency medical technicians, ambulance services or health professionals about who will live and who will die in our ICUs?”

The Minister’s response did not answer this important question. The AODA Alliance asked the Health Minister the same thing two months ago in our February 25, 2021 letter to her. The Government has never answered that question or that letter.

In Health Minister Elliott’s April 21, 2021 answer in Question Period, an impression may be created that the Government has been consulting on the critical care triage protocol. No one has consulted us on the January 13, 2021 Critical Care Triage Protocol.

  1. In its defence, the Ford Government said it is now reaching out to others outside Ontario, to see if they can bring more doctors, nurses and other needed health professionals to help out in Ontario’s intensive care units. This is a much-needed measure. It could avert the need for any critical care triage.

However, we must ask why the Ford Government was not doing this weeks and months ago, when it was given ample early warning that Ontario was at risk of critical care overload. Had it done so, we would not be facing the imminent danger we now are confronting. The Ford Government could have had in place detailed emergency plans to shuttle health care professionals to Ontario, with prior clearances from the relevant licensing bodies so they can work here in this emergency. This further illustrates Ontario’s failure to properly prepare.

For more information on these issues, visit the AODA Alliance website’s health care page.

            MORE DETAILS

Ontario Hansard April 20, 2021

Question Period

COVID-19 RESPONSE

Ms. Sara Singh: My question is for the Premier. For months, experts including members of the Premier’s own science table have been sounding the alarm about dangerously high ICU levels, and today we learned that there are over 760 people fighting for their lives in Ontario ICUs, Speaker.

But the Premier failed to act. They failed to implement paid sick days. They failed to vaccinate workers in hot spots, and now ICUs in communities like Brampton are overflowing. Pediatric hospitals are sacrificing their beds. Patients are being transferred to hospitals around the province outside of their communities, and doctors and nurses are being put in the horrific position of having to make decisions on who will receive life-saving supports and who will not.

Speaker, why—with all of the evidence in front of this government; all of the warnings from their own science tables and medical experts—does this government continue to ignore the crisis in our ICUs?

The Speaker (Hon. Ted Arnott): Minister of Health.

Hon. Christine Elliott: We have been listening to the experts all along. We have been listening to their evidence. I think one thing is really important, Speaker, and I would say to the member opposite, through you, that the speaker is alleging that there is a triage protocol in place in Ontario. There is not; there is not.

What we are doing is building capacity in our hospitals. We are making sure there are two aspects to what we need to deal with here. We need to blunt the transmission of COVID-19 in communities, as well as, right now, we need to build capacity in our hospitals, which are we are doing.

We are in contact with the CEOs of the hospitals on virtually a daily basis. They are working very hard to create spaces.

We are creating capacity so that everyone in Ontario who needs to be admitted to hospital and needs to be in an intensive care bed will have a bed available for them.

The Speaker (Hon. Ted Arnott): Supplementary?

Ms. Sara Singh: Mr. Speaker, with all due respect to the Minister of Health, that response shows us how out of touch with reality this minister is. Doctors are sounding the alarm bells and this government continues to ignore their pleas for help. The government is following a pattern of denying the problem and acting too late.

Now the government is begging other provinces for help, but refusing the federal government’s assistance and the assistance of the Red Cross. Speaker, health care systems in other provinces are also fighting COVID-19. They need their health care workers just as much as we do. It was this Premier’s responsibility and this Minister of Health’s responsibility to help protect people here in Ontario, and they failed to do that at every step of the pandemic.

This is a national and global failure and it is upsetting and heartbreaking to know that they could have acted and they chose not to. With months to plan for this crisis, why did this Premier fail to address the issues causing ICU capacity to rise, and why does the government think it’s another government’s responsibility to come and clean up their mess?

Interjections.

The Speaker (Hon. Ted Arnott): I’ll ask members to please take their seats and allow the Minister of Health to reply.

Hon. Christine Elliott: Again, through you, Mr. Speaker, I would say to the member opposite that what you’re suggesting is simply not the case. Since the beginning of this pandemic, we have been working hard to make sure that we have both the health human resources—

Ms. Sara Singh: Why are people dying?

Hon. Christine Elliott: —and the physical capacity in order to deal with what’s been happening. We have created—

Interjection.

Hon. Christine Elliott: I don’t know if the member opposite really wants to hear me, she’s—

The Speaker (Hon. Ted Arnott): I’m going to ask the Minister of Health to take her seat.

Interjections.

The Speaker (Hon. Ted Arnott): I’m going to ask the member for Brampton Centre to come to order. I’m going to ask the government House leader to come to order.

Interjection.

The Speaker (Hon. Ted Arnott): Always innocent.

I’m going to recognize the Minister of Health to conclude her response.

Hon. Christine Elliott: Thank you, Speaker. To continue, since the beginning of this pandemic, we have created over 3,100 new hospital beds, which is the equivalent of six new community hospitals. We have also added 14% to intensive care capacity, which is significant in the context of this pandemic.

We have also added resources in order to be able to deal with the health human resources that we need. We have allowed for the deployment of people from one sector to another.

Finally, I would say with respect to what’s happening with other provinces and other organizations coming in to help us, we’re very grateful for the help that’s being offered by the other provinces and we’re very grateful to the federal government for their offer of assistance from the Red Cross as well. We know that we need help right now. We have the physical capacity. We need some more health human resources and we are using those resources to make sure everyone who needs help will get help in our hospitals.

Ontario Hansard April 21, 2021

Question Period

COVID-19 RESPONSE

Mr. Joel Harden: My question is to the Minister of Health. As many people have already raised this morning, our ICUs are near the breaking point. We’re getting close to 100 patients now being treated in our ICUs, but despite this fact, the government has refused to make public its plans for critical care triage in those ICUs. We don’t know. People with disabilities and their loved ones and advocacy organizations still don’t know what has been negotiated in secret and what actually will happen when those life-and-death decisions take place but, at home, Dr. David Neilipovitz, the ICU director at the Ottawa Hospital told CBC News, “It would be naïve for us to think that triage or changes in the standard of care have not already come about.” Let’s think about that.

Yesterday, the minister rose in this House and said there is no clinical triage protocol, but we know that hospitals received one on January 13. We also know that a training was done for medical professionals on YouTube on the 23rd of January.

Speaker, I want to ask the minister, who is very well versed in these issues: What instructions have been sent out and drafted to emergency medical technicians, ambulance services or health professionals about who will live and who will die in our ICUs?

The Speaker (Hon. Ted Arnott): Minister of health.

Hon. Christine Elliott: I can certainly advise the member that no triage protocol has been activated or approved by the government of Ontario.

There have been discussions. I understand that there were a number of disability groups that were concerned with respect to a previous draft that was prepared earlier this year. That was then reviewed with the human rights commission. There have been a number of discussions about modifications to it. But nothing has been activated, nothing has been approved by this government.

What we are doing instead is to create the capacity so that we can care for all the patients that come into our hospital, whether they’re COVID patients or emergency patients that come in otherwise. We have created over 3,100 beds since this pandemic began, increased our intensive care capacity by 14%.

We are looking at bringing in other health professionals from other provinces and other countries so that, notwithstanding having the creation of those spaces, we will also have the health human resources in order to be able to operate them safely, carefully and professionally.

The Speaker (Hon. Ted Arnott): The supplementary question.

Mr. Joel Harden: Earlier today, I was joined by disability rights leaders for a media conference, all of whom are calling upon this government to make public its plans for critical care triage. Speaker, I know this minister served as Patient Ombudsperson for this province for years and knows full well that every patient, physiotypical, neurotypical or not, has a right to their care at the point of service. But the minister also should know that hospitals got a critical triage protocol on January 13, that a training has been conducted. So I must admit my extreme frustration that today, when our ICUs are nearing capacity, we are still hearing, “There are no plans.”

Speaker, let me say very clearly for this House, “I didn’t know,” at this point: not an acceptable answer. “I was just following orders,” at this point: not an acceptable answer. “Please forgive me” to disabled patients and their loved ones: not an acceptable answer.

Will you make sure that people with disabilities are not discriminated against in the ICUs: yes or no?

The Speaker (Hon. Ted Arnott): Again, I’ll ask the members to make their comments through the Chair. The Minister of Health to respond.

Hon. Christine Elliott: The rights of people with disabilities has been one of my strongest passions since I got to this place 15 years ago, and I don’t need to take any instructions from anybody—

Ms. Andrea Horwath: Ha!

Hon. Christine Elliott: —including the leader of the official opposition, about this issue. I have always stood up for the rights of people with disabilities—

Interjections.

The Speaker (Hon. Ted Arnott): Order. Opposition, come to order. The member for Northumberland–Peterborough South, come to order.

The Minister of Health, please reply.

Hon. Christine Elliott: The rights of people with disabilities have been one of the issues that we have cared about and dealt with as part of this entire pandemic. The rights of people with disabilities are equally as important as the rights of anybody else. That is something that I’ve always stood by, that

I always will stand by. I can assure the member opposite that no triage protocol has been approved. A draft was circulated in January. That was not approved by this government. It was something that had been discussed. But I understand that the rights of people with disabilities have been brought forward. I asked them—

Interjections.

The Speaker (Hon. Ted Arnott): The member for Ottawa Centre, come to order. The member for Hamilton West–Ancaster–Dundas, come to order.

The minister, please conclude her response.

Hon. Christine Elliott: I asked that this issue be dealt with, with the people with disabilities groups, as well as with the Ontario Human Rights Commission. There have been numerous discussions, but nothing has been activated yet, and I can assure you nothing has been approved at this point. We are working to make sure—

The Speaker (Hon. Ted Arnott): Thank you. The next question.

QP Briefing April 21, 2021

Originally posted at https://www.qpbriefing.com/2021/04/21/solicitor-general-brushes-off-disability-advocate-concerns-about-triage-protocol/

SOLICITOR GENERAL BRUSHES OFF DISABILITY ADVOCATE CONCERNS ABOUT TRIAGE PROTOCOL

Home Health And COVID-19 Solicitor General Brushes Off Disability Advocate Concerns About Triage Protocol

Solicitor general brushes off disability advocate concerns about triage protocol

Asked about concerns raised by disability advocates for months that the provincial triage guidelines discriminate against them, Ontario’s solicitor general got upset.

“There is no triage protocol being used,” Sylvia Jones said, cutting off the question from QP Briefing. “I am very frustrated that you continue to suggest that there is a triage protocol in place in the province of Ontario in our hospitals. Talk to the hospital CEOs, talk to the minister of health. It is not accurate.”

Jones and Health Minister Christine Elliott said the government has not approved a plan for deciding who lives and who dies should Ontario intensive care units run out of life-saving equipment.

But while it has not been officially triggered, the preparation for the nightmare scenario is real.

Hospitals received training on draft guidelines, which leaked in January, and are preparing to use them.

Doctors and nurses have told reporters that due to rising case counts in the third wave of COVID-19, triage decisions could be days away. Some say that while the protocol has not been implemented, decisions to ration or triage care are already happening, including the cancellation of scheduled surgeries.

And advocates for people with disabilities say they worry that if and when the time comes, they will be seen as less deserving of care than someone without disabilities, because of two key parts of the protocol.

One is the inclusion of the “clinical frailty scale,” which outlines how dependent people are on others to live their lives.

It “asks questions like, can you get dressed yourself, without assistance? Can you go grocery shopping without assistance? Can you use a telephone without assistance?” said Mariam Shanouda, a lawyer with Toronto’s ARCH Disability Law Centre. “And if you answer no, I can’t do any of these things without assistance, then you are less likely to access critical care. This is disability discrimination in a nutshell.”

The other major issue is that doctors are asked to estimate patients’ likelihood of surviving the next 12 months. That timeline is too long, advocates say, and could force medical staff to “guesstimate”

“Guessing is not science,” said David Lepofsky, chair of the AODA Alliance. “And it doesn’t become science because the person doing it, or who’s being mandated to do it, has a white coat on and a stethoscope.”

Another issue is that advocates don’t know whether the protocol from January is unchanged, or whether a new version is being prepared. Lepofsky said the government refuses to answer any of his calls.

“The solution is for the government to immediately make public their step-by-step plan for rolling this out, which they obviously have, so we can know what they’re planning to do,” he said.

The Ministry of Health should speak directly to disability advocacy groups like his, “so we can have input into this, rather than having to communicate with the human shields behind whom they’re hiding, such as the Bioethics Table,” he said.

And each hospital that’s done a triaging drill should make the results of that drill public, “so the public can know how much these simulations for triage might vary, depending on which hospital you happen to go to,” Lepofsky said.

Opposition leaders also called for transparency.

Green Leader Mike Schreiner said he shares the concerns of disability advocates, and argued the government should release the guidelines publicly.

He also noted that ODSP payments have not gone up recently, despite the fact that “Ontarians with disabilities have borne a disproportionate burden in this pandemic.”

Liberal health critic John Fraser said Ontario is “dangerously close to asking clinicians to decide who gets care and who doesn’t. The government needs to be open and transparent about the status of the triage protocol. I think the disability advocates have a legitimate concern. The government should have been listening from the start and needs to engage with them now.”

In question period on Wednesday, Joel Harden, the NDP critic for accessibility and persons with disabilities, quoted Dr. David Neilipovitz, the ICU director at the Ottawa Hospital, who told CBC: “‘It would be naive for us to think that triage or changes in the standard of care have not already come about.’ Let’s think about that,” he said.

“Yesterday, the minister rose in this house and said there is no clinical triage protocol, but we know that hospitals received one on January 13. We also know that a training was done for medical professionals on YouTube on the 23rd of January. Speaker, I want to ask the minister, who is very well versed in these issues: what instructions have been sent out and drafted to emergency medical technicians, ambulance services or health professionals about who will live and who will die in our ICUs?”

Elliott repeated that there is no official triage protocol yet.

“There have been discussions,” she said. “I understand that there were a number of disability groups that were concerned with respect to a previous draft that was prepared earlier this year. That was then reviewed with the human rights commission. There have been a number of discussions about modifications to it. But nothing has been activated, nothing has been approved by this government.”

It was indeed reviewed with the Ontario Human Rights Commission in December, but the organization still disapproves. Chief Commissioner Ena Chadha sent a letter to Elliott in March outlining concerns with the draft protocol and called on the government to publicly release it.

Harden said “there are no plans” is “not an acceptable answer.”

Elliott disagreed.

“The rights of people with disabilities has been one of my strongest passions since I got to this place 15 years ago,” she said, “and I don’t need to take any instructions from anybody—”

NDP Leader Andrea Horwath interjected, “Ha!”

“—including the leader of the Official Opposition, about this issue,” Elliott finished.

Ottawa Citizen Online April 22, 2021

Originally posted at https://ottawacitizen.com/opinion/harden-ontarios-covid-triage-protocol-must-respect-rights-of-the-disabled

Opinion Columnists

Harden: Ontario’s COVID triage protocol must respect rights of the disabled

Just over a year ago, 200+ community organizations urged the Ford government to remove disability discrimination from the triage guidance. The response so far: silence.

Joel Harden

The Children’s Hospital of Eastern Ontario is accepting adult critical care patients due to the growing severity of the COVID-19 crisis. PHOTO BY ERROL MCGIHON /Errol McGihon

These are perilous times in Ontario. On April 16, 2021, a record-breaking 4,812 new COVID-19 cases were recorded.

At the moment, more than 750 patients are being treated in Ontario’s ICUs. For the first time in its 47-year history, the Children’s Hospital of Eastern Ontario is accepting adult COVID-19 patients who require critical care.

There is a real possibility that by the end of the month, hospitals will have to ration or “triage” critical care due to surging COVID case counts. Triage refers to how hospitals will decide who gets life-saving care if ICUs are overwhelmed with COVID patients and they run out of beds.

Along with disability and human rights leaders, I am deeply concerned that the Doug Ford government’s current clinical triage protocol includes disability discrimination, and hasn’t been developed with adequate consultation.

What’s wrong with the triage protocol that was circulated to hospitals on Jan. 13, 2021? Firstly, it includes a “clinical frailty scale,” meaning that a patient over the age of 65 with a progressive disease (Alzheimers, Muscular Dystrophy etc.) will be evaluated based on how they can perform 11 different activities of daily living without assistance. This is blatantly discriminatory against people with disabilities, millions of whom require varying degrees of assistance to live their fullest lives.

Secondly, it includes criteria that assess the patient’s likelihood of mortality one year from their admission to hospital. Even ICU doctors have conceded that such assessments are “guesstimates” rather than an exact science. This leaves the door open to subjective judgments about a person’s quality of life that could discriminate against people with disabilities, as opposed to a shorter-term assessment of mortality.

No one is suggesting that Ontario shouldn’t have a triage protocol in place if ICUs are filled to maximum capacity. What we are saying is that the protocol must respect human rights and the rule of law. It also needs to be discussed openly and transparently, but this government has taken the opposite approach.

Members of the government’s own bioethics table have criticized the secrecy with which the government has been handling its approach to clinical triage. Noting that the process must be “informed, transparent, inclusive, reasonable and subject to revision in light of new information or legitimate concerns or claims,” they believe that Ontario has failed to meet these requirements.

News media have also reported that the Ford government is considering suspending parts of the Health Care Consent Act (HCCA), which requires doctors to obtain consent from a patient or their substitute decision maker before they withdraw critical care.

It is unacceptable for the government to make life-and-death decisions by a secret memo. If they are considering suspending the HCCA, they must make the details public and have a proper debate in the legislature.

Just over a year ago, 200+ community organizations wrote to the Ford government urging it to remove disability discrimination from the province’s triage protocol. For more than a year, the government has been aware of these concerns and had ample time to consult with disability and human rights leaders in developing its clinical triage protocol.

How has the Ford government responded? With complete silence. It has ignored direct appeals from disability groups, the Ontario Human Rights Commission and the opposition, all of whom have expressed concerns with the Jan. 13 “emergency standard of care” triage protocol.

What message does this send to the 2.6 million people with disabilities who live in Ontario? People with disabilities are more likely to get COVID-19, and to be seriously impacted by the virus. This government must assure them that they won’t face any discrimination in the awful event that triage becomes necessary.

It’s time to stop the secrecy surrounding critical care triage. It’s time for the Ford government to remove disability discrimination from its clinical triage protocol.

Joel Harden is the NDP MPP for Ottawa Centre and opposition critic, accessibility and persons with disabilities.

New Democratic Party April 21, 2021 News Release

NDP MPP Joel Harden, disability rights advocates call on Ford to remove disability discrimination from triage protocol

QUEENS PARK — MPP Joel Harden (Ottawa Centre), the NDP’s critic for Accessibility and Persons with Disabilities, called on the Ford government to withdraw disability discrimination from Ontario’s clinical triage protocol and immediately hold a public consultation on how care will be triaged if ICUs become too overwhelmed to fully treat everyone.

Harden was joined at a Wednesday morning press conference by David Lepofsky, Chair of the AODA Alliance, Sarah Jama, Co-founder of the Disability Justice Network of Ontario, and Mariam Shanouda, Staff Lawyer at ARCH Disability Law Centre, all of whom are expressing deep concerns about the protocol and the secrecy surrounding it.

“We should never have gotten to the point where critical care triage became a possibility, but the Ford government’s choice to put money and politics ahead of public health has brought ICUs to the breaking point,” said Harden. “The government must remove disability discrimination from its triage protocol, and assure people with disabilities that they won’t be deprioritized for life-saving critical care.”

The Ford government continues to ignore human rights concerns raised by disability rights leaders, and the Ontario Human Rights Commission about its approach to clinical triage. They have not held open consultations, and it was disability organizations and the opposition, not the government, that made public the January 13, 2021 triage protocol which was sent to hospitals.

“This entire process has been cloaked in secrecy,” said Harden. “That’s wrong, and it’s time for the government to stop making life-and-death decisions behind closed doors.”

Quotes:

David Lepofsky, Chair, AODA Alliance
“Our non-partisan grassroots coalition agrees that Ontario must be prepared for the possibility of critical care triage, but Ontario’s plan must include a triage protocol, mandated by the Legislature, that does not violate the Charter of Rights or the Ontario Human Rights Code by discriminating against people with disabilities or denying them due process. They have already disproportionately suffered the hardships of the COVID-19 pandemic.”

 

Sarah Jama, Co-founder, Disability Justice Network of Ontario
“We are in a time of deep crisis, and need to offer paid sick days and increase social assistance rates for community members without work from home jobs, or a safety net. But rather than make these preventative policy decisions, our government has created conditions where doctors must rank who gets to live and who gets to die.”

 

Mariam Shanouda, Staff Lawyer, ARCH Disability Law Centre
“Health care, including critical care during a pandemic, must be available free from unlawful discrimination. This is a life and death non-partisan issue. The choice must not be whether we have no triage plan or one that discriminates. And let’s be clear, the current plan is discriminatory and will disproportionately impact persons with disabilities who have already disproportionately experienced devastating consequences from this pandemic.”



Source link

Register for April 20, 2021 Virtual Public Forum on Disability Concerns with Ontario’s Critical Care Triage Plans


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

April 16, 2021

SUMMARY

Please save the date for these two important events that are fast approaching. For the first one, register now. For the second one, stay tuned for details on how to register to take part.

Please publicize both of these events widely on social media, and by carrier pigeon (but only if the birds are socially distancing).

MORE DETAILS

1. Register to Attend the Online Public Forum on Tuesday, April 20, 2021, on the Danger Facing People with Disabilities if Ontario Must Ration or Triage Life-Saving Critical Care

The newest wave of COVID is overloading Ontario intensive care units, which is what triggered Ontario’s latest lockdown. As a result, life-saving critical care in Ontario hospitals could very soon be rationed or “triaged.” Serious concerns about the triage protocol have been raised by disability organizations such as ARCH Disability Law Centre and the Accessibility for Ontarians with Disabilities Act Alliance.

This is a time-sensitive issue. We encourage you to join us on Tuesday, April 20 at 7:30 p.m. for a virtual information session to learn more about Ontario’s triage protocol and why it matters. LEARN MORE AND REGISTER NOW! (ASL and closed captioning will be available)

For background on the AODA Alliance’s efforts to battle the danger of disability discrimination in critical care triage, visit the AODA Alliance website’s health care page.

2. Save the Date! On Wednesday, April 28, 2021, Tell the Online Meeting of Toronto’s Infrastructure and Environment Committee Not to Allow Electric Scooters in Toronto

On Wednesday, April 28, 2021, the City of Toronto’s Infrastructure and Environment Committee will be discussing whether Toronto should lift the ban on riding electric scooters in public places. Members of the public will be able to register in advance to speak to that Committee at that meeting before it debates the issue. We urge as many people as possible to sign up to speak against allowing e-scooters. E-scooters endanger the safety of the public, including people with disabilities, and will create new barriers impeding people with disabilities.

We will let you know when you can sign up, and how to register to present. That opportunity to register may not open up until just a few days before the April 28, 2021 meeting.

Members of the public each get only 3 to 5 minutes to speak, so you don’t have to talk long. You can even speak for a shorter time and just tell the members of City Council not to allow e-scooters.

We know the e-scooter corporate lobbyists will be organizing to again pressure City Council. We want City Council to stand up for people with disabilities and to stand up to the e-scooter corporate lobbyists.

Stay tuned for more information on this. You can learn all about our efforts to protect people with disabilities from e-scooters by visiting the AODA Alliance website’s e-scooter page.




Source link

Register for April 20, 2021 Virtual Public Forum on Disability Concerns with Ontario’s Critical Care Triage Plans – Plan to Tell The Virtual April 28, 2021 Toronto Infrastructure and Environment Committee Meeting Not to Allow Electric Scooters


Accessibility for Ontarians with Disabilities Act Alliance Update

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

Web: www.aodaalliance.org Email: [email protected] Twitter: @aodaalliance Facebook: www.facebook.com/aodaalliance/

Register for April 20, 2021 Virtual Public Forum on Disability Concerns with Ontario’s Critical Care Triage Plans – Plan to Tell The Virtual April 28, 2021 Toronto Infrastructure and Environment Committee Meeting Not to Allow Electric Scooters

April 16, 2021

            SUMMARY

Please save the date for these two important events that are fast approaching. For the first one, register now. For the second one, stay tuned for details on how to register to take part.

Please publicize both of these events widely on social media, and by carrier pigeon (but only if the birds are socially distancing).

            MORE DETAILS

1. Register to Attend the Online Public Forum on Tuesday, April 20, 2021, on the Danger Facing People with Disabilities if Ontario Must Ration or Triage Life-Saving Critical Care

The newest wave of COVID is overloading Ontario intensive care units, which is what triggered Ontario’s latest lockdown. As a result, life-saving critical care in Ontario hospitals could very soon be rationed or “triaged.” Serious concerns about the triage protocol have been raised by disability organizations such as ARCH Disability Law Centre and the Accessibility for Ontarians with Disabilities Act Alliance.

This is a time-sensitive issue. We encourage you to join us on Tuesday, April 20 at 7:30 p.m. for a virtual information session to learn more about Ontario’s triage protocol and why it matters.

LEARN MORE AND REGISTER NOW! (ASL and closed captioning will be available)

For background on the AODA Alliance’s efforts to battle the danger of disability discrimination in critical care triage, visit the AODA Alliance website’s health care page.

2. Save the Date! On Wednesday, April 28, 2021, Tell the Online Meeting of Toronto’s Infrastructure and Environment Committee Not to Allow Electric Scooters in Toronto

On Wednesday, April 28, 2021, the City of Toronto’s Infrastructure and Environment Committee will be discussing whether Toronto should lift the ban on riding electric scooters in public places. Members of the public will be able to register in advance to speak to that Committee at that meeting before it debates the issue. We urge as many people as possible to sign up to speak against allowing e-scooters. E-scooters endanger the safety of the public, including people with disabilities, and will create new barriers impeding people with disabilities.

We will let you know when you can sign up, and how to register to present. That opportunity to register may not open up until just a few days before the April 28, 2021 meeting.

Members of the public each get only 3 to 5 minutes to speak, so you don’t have to talk long. You can even speak for a shorter time and just tell the members of City Council not to allow e-scooters.

We know the e-scooter corporate lobbyists will be organizing to again pressure City Council. We want City Council to stand up for people with disabilities and to stand up to the e-scooter corporate lobbyists.

Stay tuned for more information on this. You can learn all about our efforts to protect people with disabilities from e-scooters by visiting the AODA Alliance website’s e-scooter page.



Source link

As COVID-19 Infections Hit Record Highs and Hospital ICUs Reach the Brink, Six Bioethicists on The Ford Government’s Bioethics Table Release a Public Statement Revealing Major Concerns with Ontario’s Plans for Triage of Critical Care, that Echo Disability Community Objections


ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT ALLIANCE

NEWS RELEASE – FOR IMMEDIATE RELEASE

As COVID-19 Infections Hit Record Highs and Hospital ICUs Reach the Brink, Six Bioethicists on The Ford Government’s Bioethics Table Release a Public Statement Revealing Major Concerns with Ontario’s Plans for Triage of Critical Care, that Echo Disability Community Objections

April 15, 2021 Toronto: A body blow has just been delivered to the Ford Government’s controversial plans for deciding which patients would be refused life-saving critical care, if the crisis overload in Ontario hospital intensive care units requires that life-saving critical care must be rationed or “triaged”. Six members of the Ford Government’s own advisory “Bioethics Table” have today published an online statement, set out below, that strongly criticizes Ontario’s critical care triage plans. Their concerns reflect serious objections to Ontario’s triage plans from the disability community, including from the AODA Alliance.

The six bioethicists (who don’t claim to speak for the entire Bioethics Table) urge that the Government should now reveal its secret critical care triage plans to the public, should consult the public, and should hold and open discussion of how critical care should be triaged, if rationing becomes necessary, without treating this as a purely clinical issue or one for bioethicists to monopolize. (Key excerpts also set out below)

These six authors make it clear that Ontario needs a better approach to critical care triage. This is a direct blast at the Ford Government’s persistent secrecy on this issue and its refusal to speak directly to key stakeholders like those from the disability community. We offer the example that the Government has refused to even answer eight detailed letters from the AODA Alliance since last September which identify well-researched objections.

The six bioethicists explain that decisions over who should get life-saving critical care and who should be refused it during critical care triage is not simply a clinical question (i.e. one of medical science alone). Ontario’s secret critical care triage protocol treats this triage as purely a clinical question. The six authors humbly emphasize that bioethicists themselves have no monopoly on wisdom in the area of how critical care triage should be conducted.

These authors urge that it is important to respect the human rights of disadvantaged groups in society. We add that the AODA Alliance and others have been showing for months that Ontario’s plans are replete with disability discrimination, contrary to the Ontario Human Rights Code.

We expect that the Ford Government will answer that the Bioethics Table, of whom these six authors are a part, held consultations with a number of disability advocates, including the AODA Alliance. That would be no answer. Those discussions ended months ago. The external Bioethics Table only gives advice to The Government. The Bioethics Table makes no decisions on how critical care triage should be conducted, and rejected some of our major concerns without giving reasons for doing so. Those in the Government who do make the decisions have steadfastly refused to talk to us. The Government has hidden behind them for months, like human shields.

The secret January 13, 2021 Critical Care Triage Protocol is not available on any Government website, but is available on the AODA Alliance website.

In light of this important statement by several of The Government’s own external advisors, the AODA Alliance calls on the Ford Government to take these four urgent steps:

  1. Now make public the current version of the critical care triage protocol, all reports and recommendations by its external Bioethics Table since September 11, 2021, The Government’s plan of action for rolling out critical care triage if needed, and the results of drills or simulations of critical care triage held at any Ontario hospitals.
  2. Remove disability discrimination from the January 13, 2021 Critical Care Triage Protocol, and
  3. Immediately hold a public consultation on how critical care triage should be conducted.
  4. Introduce legislation on critical care triage for debate in the Legislature, rather than dealing with it by an internal memo to hospitals.

Key statements to this effect by the six bioethicists on the Ford Government’s external Bioethics Table in this article include:

“As bioethicists involved in developing an ethical framework for ICU triage at the Ontario COVID-19 Bioethics Table, we have serious concerns about the lack of transparency and public engagement around the constraints the Table works under.”

“We are beholden to the public as bioethicists helping to develop guidance for the ethical use of public resources – especially to the people most likely to be impacted by intensive care triage decisions – as well as to the physicians who will be forced to make these fraught decisions. This requires that the process be informed, transparent, inclusive, reasonable and subject to revision in light of new information or legitimate concerns or claims.

To date, these requirements have not been met in several provinces, including Ontario, and we entreat governments to make available their triage frameworks and protocols for public deliberation.”

“Science alone cannot tell us how to allocate ICU beds.”

“Whose lives we save is not just a matter of how we apply clinical criteria. It is a matter of redressing unfair inequalities in health and a matter of protecting fundamental human rights.

And while utility is one worthwhile objective of health policy, it must be balanced with due consideration of the human rights of people who might be disproportionately, unjustifiably or morally harmed by clinically based triage decisions. Relying on clinical criteria like judgments about mortality risk in the short or long term, functional status or clinical frailty scores compounds health inequities by failing to help distribute health benefits fairly across society through explicit consideration of social disadvantage.

Human rights advocates, disability rights advocates, Indigenous health partners and members of the Black community have voiced concerns about the potential for discrimination when triage does not take stock of societal factors and when they are not involved in the process of developing triage criteria. Meaningful inclusion of these communities and their perspectives is essential for the ethical legitimacy of ICU triage frameworks to balance utility with equity.

The public needs to join the conversation on an ethical approach to triage”

“Bioethicists are not moral authorities, and governments ought not decide on an approach to intensive care triage without engaging in broader moral deliberation with the public and with those who will be most affected.”

“It is a distinctly political obligation to ensure that the triage protocol is grounded in an ethical, democratic process and that it is based on values that have been justified through stated public reasons.

“We join the COVID-19 Bioethics Table, the Ontario Human Rights Commission and disability rights advocates in calling for transparency and public deliberation on the unfinished work of developing Ontario’s approach to critical care triage in a major surge during the COVID-19 pandemic.”

“The protection of fundamental legal and human rights during an emergency is a litmus test for society, and we need to do everything in our power to avoid overriding rights unjustifiably. Without public discussion, the vulnerability of already marginalized groups is intensified and trust eroded.”

Contact: AODA Alliance Chair David Lepofsky, [email protected]

For More Background

  1. The AODA Alliance’s new February 25, 2021 independent report on Ontario’s plans for critical care triage if hospitals are overwhelmed by patients needing critical care.
  2. Ontario’s January 13, 2021 triage protocol.
  3. The eight unanswered letters from the AODA Alliance to the Ford Government on its critical care triage plan, including the AODA Alliance‘s September 25, 2020 letter, its November 2, 2020 letter, its November 9, 2020 letter, its December 7, 2020 letter, its December 15, 2020 letter, its December 17, 2020 letter, its January 18, 2021 letter and its February 25, 2021 letter to Health Minister Christine Elliott.
  4. The Government’s earlier external advisory Bioethics Table’s September 11, 2020 draft critical care triage protocol, finally revealed in December 2020.
  5. The AODA Alliance website’s health care page, detailing its efforts to tear down barriers in the health care system facing patients with disabilities, and our COVID-19 page, detailing our efforts to address the needs of people with disabilities during the COVID-19 crisis.

Healthy Debate April 15, 2021

Originally posted at https://healthydebate.ca/opinions/icu-triage/?utm_source=mailpoet&utm_medium=email&utm_campaign=we-need-to-talk-about-triaging-critical-care_12

Opinion

Public conversation on the ethics of intensive care triage during pandemic is overdue

by Alison Thompson, Paula Chidwick, Lisa Jennifer Schwartz, Stephanie Nixon, Lisa Forman, Robert Sibbald

COVID-19 has highlighted the ethical challenges in our health-care system, and nowhere is this more apparent than in an overcrowded intensive care unit. ICUs are where the sickest of the sick receive life-saving treatments and where their crashing bodily functions are taken over by high-tech machines.

Even when there isn’t a pandemic, not everyone can get access to intensive care, and not everyone will benefit from it. It is costly, invasive and requires a highly skilled workforce to make it run.

In the early days of the COVID-19 pandemic, people around the world were shocked by the images of ICU doctors working around the clock in Wuhan, Turin and New York. Their faces were etched with bruises from their tight-fitting face masks. Their eyes were haunted by the sheer number of patients they were treating – and by the sheer number they couldn’t treat.

These early warnings from other countries signaled that Canadian provinces needed to avoid a major surge of patients that would strain intensive care resources. But, preparing for the worst, work on guidance for intensive care triage began very early on in the pandemic, with Saskatchewan and Quebec starting in late winter 2020 and Ontario in the spring of 2020 across several of its COVID-19 advisory tables.

As bioethicists involved in developing an ethical framework for ICU triage at the Ontario COVID-19 Bioethics Table, we have serious concerns about the lack of transparency and public engagement around the constraints the Table works under. To be clear, we do not speak on behalf of the COVID-19 Bioethics Table, but we do speak as scholars in clinical and public health ethics and in human rights law who are also members of that Table.

We are beholden to the public as bioethicists helping to develop guidance for the ethical use of public resources – especially to the people most likely to be impacted by intensive care triage decisions – as well as to the physicians who will be forced to make these fraught decisions. This requires that the process be informed, transparent, inclusive, reasonable and subject to revision in light of new information or legitimate concerns or claims.

To date, these requirements have not been met in several provinces, including Ontario, and we entreat governments to make available their triage frameworks and protocols for public deliberation.

Rationing intensive care beds is fundamentally an ethical endeavour

Science alone cannot tell us how to allocate ICU beds. Should they go to the sickest patients? Should they go to those who are most likely to benefit from treatment? Should we use a lottery system? Should we withdraw treatment from patients if they are not going to have a meaningful recovery to give the bed to someone who will? And what constitutes a meaningful recovery? These are ethical questions requiring value judgements.

Many pandemic response plans focus on maximizing the benefit of scarce resources to save the most lives. Allocating ICU beds to people who are unlikely to benefit from them is often considered unethical and inefficient. Clinicians who work in the ICU often talk about the moral difficulty of providing treatments that sometimes do more harm than good. The moral burden of care in these circumstances weighs heavily on ICU clinicians when left to make these decisions alone and without ethical guidance.

How should health equity be balanced with utility in intensive care triage?

Society’s failure to address upstream causes of ill health and inequities means that the futility or efficacy of ICU care is often determined well before people are brought to the doors of an ICU. To fail to attend to this in triage frameworks and clinical protocols undermines trust. Whose lives we save is not just a matter of how we apply clinical criteria. It is a matter of redressing unfair inequalities in health and a matter of protecting fundamental human rights.

And while utility is one worthwhile objective of health policy, it must be balanced with due consideration of the human rights of people who might be disproportionately, unjustifiably or morally harmed by clinically based triage decisions. Relying on clinical criteria like judgments about mortality risk in the short or long term, functional status or clinical frailty scores compounds health inequities by failing to help distribute health benefits fairly across society through explicit consideration of social disadvantage.

Human rights advocates, disability rights advocates, Indigenous health partners and members of the Black community have voiced concerns about the potential for discrimination when triage does not take stock of societal factors and when they are not involved in the process of developing triage criteria. Meaningful inclusion of these communities and their perspectives is essential for the ethical legitimacy of ICU triage frameworks to balance utility with equity.

The public needs to join the conversation on an ethical approach to triage

Consensus on a proposed ethical framework for pandemic triage, even just among bioethicists, is unrealistic. Nor is it necessarily desirable. In fact, the role of dissensus in bioethics is crucial to avoiding the narrowing of possible policy avenues and avoiding presumptive constructions of various stakeholders.

As bioethicists, our expertise is in sketching the moral landscape, providing options and framing ethical debate. Our job is to propose a possible approach to intensive care triage that the public and stakeholders can then weigh and deliberate. It is also to propose and promote accessible and ethically defensible processes for doing so.

Bioethicists are not moral authorities, and governments ought not decide on an approach to intensive care triage without engaging in broader moral deliberation with the public and with those who will be most affected.

To be sure, public deliberation will not make the decisions about how to prioritize patients for intensive care any easier, nor will it necessarily make it easier to live with the consequences. But it would ensure that all voices have been heard, innovative approaches have been considered, and that new ethical considerations can come to light. It is a distinctly political obligation to ensure that the triage protocol is grounded in an ethical, democratic process and that it is based on values that have been justified through stated public reasons.

We join the COVID-19 Bioethics Table, the Ontario Human Rights Commission and disability rights advocates in calling for transparency and public deliberation on the unfinished work of developing Ontario’s approach to critical care triage in a major surge during the COVID-19 pandemic. Other provinces must also follow suit. Specific attention needs to be paid to partnering with people who have been marginalized by both the process and the products of ICU triage development.

The protection of fundamental legal and human rights during an emergency is a litmus test for society, and we need to do everything in our power to avoid overriding rights unjustifiably. Without public discussion, the vulnerability of already marginalized groups is intensified and trust eroded.

No province in Canada can claim to have a morally legitimate and human rights compliant approach to triage until an accessible and public discussion takes place about how to balance equity with the aim of saving lives in a pandemic.



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As COVID-19 Infections Hit Record Highs and Hospital ICUs Reach the Brink, Five Bioethicists on The Ford Government’s Bioethics Table Release a Public Statement Revealing Major Concerns with Ontario’s Plans for Triage of Critical Care, that Echo Disability Community Objections


ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT ALLIANCE
NEWS RELEASE – FOR IMMEDIATE RELEASE

April 15, 2021 Toronto: A body blow has just been delivered to the Ford Government’s controversial plans for deciding which patients would be refused life-saving critical care, if the crisis overload in Ontario hospital intensive care units requires that life-saving critical care must be rationed or “triaged”. Five members of the Ford Government’s own advisory “Bioethics Table” have today published an online statement, set out below, that strongly criticizes Ontario’s critical care triage plans. Their concerns reflect serious objections to Ontario’s triage plans from the disability community, including from the AODA Alliance.

The five bioethicists (who don’t claim to speak for the entire Bioethics Table) urge that the Government should now reveal its secret critical care triage plans to the public, should consult the public, and should hold and open discussion of how critical care should be triaged, if rationing becomes necessary, without treating this as a purely clinical issue or one for bioethicists to monopolize. (Key excerpts also set out below)

These five authors make it clear that Ontario needs a better approach to critical care triage. This is a direct blast at the Ford Government’s persistent secrecy on this issue and its refusal to speak directly to key stakeholders like those from the disability community. We offer the example that the Government has refused to even answer eight detailed letters from the AODA Alliance since last September which identify well-researched objections.

The five bioethicists explain that decisions over who should get life-saving critical care and who should be refused it during critical care triage is not simply a clinical question (i.e. one of medical science alone). Ontario’s secret critical care triage protocol treats this triage as purely a clinical question. The five authors humbly emphasize that bioethicists themselves have no monopoly on wisdom in the area of how critical care triage should be conducted.

These authors urge that it is important to respect the human rights of disadvantaged groups in society. We add that the AODA Alliance and others have been showing for months that Ontario’s plans are replete with disability discrimination, contrary to the Ontario Human Rights Code.

We expect that the Ford Government will answer that the Bioethics Table, of whom these five authors are a part, held consultations with a number of disability advocates, including the AODA Alliance. That would be no answer. Those discussions ended months ago. The external Bioethics Table only gives advice to The Government. The Bioethics Table makes no decisions on how critical care triage should be conducted, and rejected some of our major concerns without giving reasons for doing so. Those in the Government who do make the decisions have steadfastly refused to talk to us. The Government has hidden behind them for months, like human shields.

The secret January 13, 2021 Critical Care Triage Protocol is not available on any Government website, but is available on the AODA Alliance website.

In light of this important statement by several of The Government’s own external advisors, the AODA Alliance calls on the Ford Government to take these four urgent steps:

1. Now make public the current version of the critical care triage protocol, all reports and recommendations by its external Bioethics Table since September 11, 2021, The Government’s plan of action for rolling out critical care triage if needed, and the results of drills or simulations of critical care triage held at any Ontario hospitals.

2. Remove disability discrimination from the January 13, 2021 Critical Care Triage Protocol, and

3. Immediately hold a public consultation on how critical care triage should be conducted.

4. Introduce legislation on critical care triage for debate in the Legislature, rather than dealing with it by an internal memo to hospitals.

Key statements to this effect by the five bioethicists on the Ford Government’s external Bioethics Table in this article include:

“As bioethicists involved in developing an ethical framework for ICU triage at the Ontario COVID-19 Bioethics Table, we have serious concerns about the lack of transparency and public engagement around the constraints the Table works under.”

“We are beholden to the public as bioethicists helping to develop guidance for the ethical use of public resources especially to the people most likely to be impacted by intensive care triage decisions as well as to the physicians who will be forced to make these fraught decisions. This requires that the process be informed, transparent, inclusive, reasonable and subject to revision in light of new information or legitimate concerns or claims.

To date, these requirements have not been met in several provinces, including Ontario, and we entreat governments to make available their triage frameworks and protocols for public deliberation.”

“Science alone cannot tell us how to allocate ICU beds.”

“Whose lives we save is not just a matter of how we apply clinical criteria. It is a matter of redressing unfair inequalities in health and a matter of protecting fundamental human rights.

And while utility is one worthwhile objective of health policy, it must be balanced with due consideration of the human rights of people who might be disproportionately, unjustifiably or morally harmed by clinically based triage decisions. Relying on clinical criteria like judgments about mortality risk in the short or long term, functional status or clinical frailty scores compounds health inequities by failing to help distribute health benefits fairly across society through explicit consideration of social disadvantage.

Human rights advocates, disability rights advocates, Indigenous health partners and members of the Black community have voiced concerns about the potential for discrimination when triage does not take stock of societal factors and when they are not involved in the process of developing triage criteria. Meaningful inclusion of these communities and their perspectives is essential for the ethical legitimacy of ICU triage frameworks to balance utility with equity.

The public needs to join the conversation on an ethical approach to triage”

“Bioethicists are not moral authorities, and governments ought not decide on an approach to intensive care triage without engaging in broader moral deliberation with the public and with those who will be most affected.”

“It is a distinctly political obligation to ensure that the triage protocol is grounded in an ethical, democratic process and that it is based on values that have been justified through stated public reasons.

“We join the COVID-19 Bioethics Table, the Ontario Human Rights Commission and disability rights advocates in calling for transparency and public deliberation on the unfinished work of developing Ontario’s approach to critical care triage in a major surge during the COVID-19 pandemic.”

“The protection of fundamental legal and human rights during an emergency is a litmus test for society, and we need to do everything in our power to avoid overriding rights unjustifiably. Without public discussion, the vulnerability of already marginalized groups is intensified and trust eroded.”

Contact: AODA Alliance Chair David Lepofsky, [email protected]

For More Background

1. The AODA Alliance’s new February 25, 2021 independent report on Ontario’s plans for critical care triage if hospitals are overwhelmed by patients needing critical care.

2. Ontario’s January 13, 2021 triage protocol.

3. The eight unanswered letters from the AODA Alliance to the Ford Government on its critical care triage plan, including the AODA Alliance’s September 25, 2020 letter, its November 2, 2020 letter, its November 9, 2020 letter, its December 7, 2020 letter, its December 15, 2020 letter, its December 17, 2020 letter, its January 18, 2021 letter and its February 25, 2021 letter to Health Minister Christine Elliott.

4. The Government’s earlier external advisory Bioethics Table’s September 11, 2020 draft critical care triage protocol, finally revealed in December 2020.

5. The AODA Alliance website’s health care page, detailing its efforts to tear down barriers in the health care system facing patients with disabilities, and our COVID-19 page, detailing our efforts to address the needs of people with disabilities during the COVID-19 crisis.

Healthy Debate April 15, 2021

Originally posted at https://healthydebate.ca/opinions/icu-triage/?utm_source=mailpoet&utm_medium=email&utm_campaign=we-need-to-talk-about-triaging-critical-care_12

Opinion

Public conversation on the ethics of intensive care triage during pandemic is overdue
by Alison Thompson, Paula Chidwick, Lisa Jennifer Schwartz, Stephanie Nixon, Lisa Forman, Robert Sibbald

COVID-19 has highlighted the ethical challenges in our health-care system, and nowhere is this more apparent than in an overcrowded intensive care unit. ICUs are where the sickest of the sick receive life-saving treatments and where their crashing bodily functions are taken over by high-tech machines.

Even when there isn’t a pandemic, not everyone can get access to intensive care, and not everyone will benefit from it. It is costly, invasive and requires a highly skilled workforce to make it run.

In the early days of the COVID-19 pandemic, people around the world were shocked by the images of ICU doctors working around the clock in Wuhan, Turin and New York. Their faces were etched with bruises from their tight-fitting face masks. Their eyes were haunted by the sheer number of patients they were treating and by the sheer number they couldn’t treat.

These early warnings from other countries signaled that Canadian provinces needed to avoid a major surge of patients that would strain intensive care resources. But, preparing for the worst, work on guidance for intensive care triage began very early on in the pandemic, with Saskatchewan and Quebec starting in late winter 2020 and Ontario in the spring of 2020 across several of its COVID-19 advisory tables.

As bioethicists involved in developing an ethical framework for ICU triage at the Ontario COVID-19 Bioethics Table, we have serious concerns about the lack of transparency and public engagement around the constraints the Table works under. To be clear, we do not speak on behalf of the COVID-19 Bioethics Table, but we do speak as scholars in clinical and public health ethics and in human rights law who are also members of that Table.

We are beholden to the public as bioethicists helping to develop guidance for the ethical use of public resources especially to the people most likely to be impacted by intensive care triage decisions as well as to the physicians who will be forced to make these fraught decisions. This requires that the process be informed, transparent, inclusive, reasonable and subject to revision in light of new information or legitimate concerns or claims.

To date, these requirements have not been met in several provinces, including Ontario, and we entreat governments to make available their triage frameworks and protocols for public deliberation.

Rationing intensive care beds is fundamentally an ethical endeavour

Science alone cannot tell us how to allocate ICU beds. Should they go to the sickest patients? Should they go to those who are most likely to benefit from treatment? Should we use a lottery system? Should we withdraw treatment from patients if they are not going to have a meaningful recovery to give the bed to someone who will? And what constitutes a meaningful recovery? These are ethical questions requiring value judgements.

Many pandemic response plans focus on maximizing the benefit of scarce resources to save the most lives. Allocating ICU beds to people who are unlikely to benefit from them is often considered unethical and inefficient. Clinicians who work in the ICU often talk about the moral difficulty of providing treatments that sometimes do more harm than good. The moral burden of care in these circumstances weighs heavily on ICU clinicians when left to make these decisions alone and without ethical guidance.

How should health equity be balanced with utility in intensive care triage?

Society’s failure to address upstream causes of ill health and inequities means that the futility or efficacy of ICU care is often determined well before people are brought to the doors of an ICU. To fail to attend to this in triage frameworks and clinical protocols undermines trust. Whose lives we save is not just a matter of how we apply clinical criteria. It is a matter of redressing unfair inequalities in health and a matter of protecting fundamental human rights.

And while utility is one worthwhile objective of health policy, it must be balanced with due consideration of the human rights of people who might be disproportionately, unjustifiably or morally harmed by clinically based triage decisions. Relying on clinical criteria like judgments about mortality risk in the short or long term, functional status or clinical frailty scores compounds health inequities by failing to help distribute health benefits fairly across society through explicit consideration of social disadvantage.

Human rights advocates, disability rights advocates, Indigenous health partners and members of the Black community have voiced concerns about the potential for discrimination when triage does not take stock of societal factors and when they are not involved in the process of developing triage criteria. Meaningful inclusion of these communities and their perspectives is essential for the ethical legitimacy of ICU triage frameworks to balance utility with equity.

The public needs to join the conversation on an ethical approach to triage

Consensus on a proposed ethical framework for pandemic triage, even just among bioethicists, is unrealistic. Nor is it necessarily desirable. In fact, the role of dissensus in bioethics is crucial to avoiding the narrowing of possible policy avenues and avoiding presumptive constructions of various stakeholders.

As bioethicists, our expertise is in sketching the moral landscape, providing options and framing ethical debate. Our job is to propose a possible approach to intensive care triage that the public and stakeholders can then weigh and deliberate. It is also to propose and promote accessible and ethically defensible processes for doing so.

Bioethicists are not moral authorities, and governments ought not decide on an approach to intensive care triage without engaging in broader moral deliberation with the public and with those who will be most affected.

To be sure, public deliberation will not make the decisions about how to prioritize patients for intensive care any easier, nor will it necessarily make it easier to live with the consequences. But it would ensure that all voices have been heard, innovative approaches have been considered, and that new ethical considerations can come to light. It is a distinctly political obligation to ensure that the triage protocol is grounded in an ethical, democratic process and that it is based on values that have been justified through stated public reasons.

We join the COVID-19 Bioethics Table, the Ontario Human Rights Commission and disability rights advocates in calling for transparency and public deliberation on the unfinished work of developing Ontario’s approach to critical care triage in a major surge during the COVID-19 pandemic. Other provinces must also follow suit. Specific attention needs to be paid to partnering with people who have been marginalized by both the process and the products of ICU triage development.

The protection of fundamental legal and human rights during an emergency is a litmus test for society, and we need to do everything in our power to avoid overriding rights unjustifiably. Without public discussion, the vulnerability of already marginalized groups is intensified and trust eroded.

No province in Canada can claim to have a morally legitimate and human rights compliant approach to triage until an accessible and public discussion takes place about how to balance equity with the aim of saving lives in a pandemic.




Source link