From Alabama to Utah, the criteria given by administrations to doctors exclude the most vulnerable
In Tennessee, people with spinal muscular atrophy will be "excluded" from intensive care. In Minnesota, cirrhosis of the liver, lung disease and heart failure will take away the right to a respirator from patients with Covid-19. Michigan will give priority to workers in essential services. And in Washington State, the first to be affected by the coronavirus, as well as in those of New York, Alabama, Tennessee, Utah, Minnesota, Colorado and Oregon, doctors are called to evaluate the level of general physical and intellectual ability before intervene, or not, to save a life.
While the first wave of coronavirus cases is breaking out in the United States and hospitals are preparing to be invaded by patients with breathing difficulties, the various States are trying to provide doctors with guiding criteria for making the most difficult decisions: choosing who to attack. a respirator and who not. Different approaches emerge in the plans prepared or reviewed these days by local experts. But also a disturbing trend. Among the approximately 36 states that have disclosed their criteria, a dozen also list intellectual considerations, and others speak of precise conditions that can lead to discrimination against disabled people. Alabama is the most striking case. In his paper entitled Scarce Resource Management he claims that "mentally disabled people are unlikely candidates for breathing support."
But also phrases contained in the guidelines of Washington, such as "cognitive ability", or of Maryland and Pennsylvania, such as "severe neurological disorder", have raised the alarm of the defense associations of disabled people. Three groups already (Disability Rights Washington, Self Advocates in Leadership, The Arc of the United States) sued Washington State to prevent the entry into force of the criteria for access to life-saving care for Covid-19.
And half a dozen other organizations have appealed to the federal government to impose on local governments and hospitals the principle that disabled people are entitled to the same treatment as others. It is frightening that the criteria for access to care are built on the idea that some lives are worth less than others. "People with disabilities are terrified that if resources become scarce, they will be sent to the bottom of the line - says Ari Ne'eman, professor at the Lurie Institute for Disability Policy of the Brandeis University -. And they are right, because many states affirm it quite explicitly in their criteria ".
Beyond individual documents, in the United States seeking to prepare for insufficient ICU beds, another disturbing principle has already emerged for the most vulnerable. This is the "golden rule" present in almost all resource management documents: a patient is asked if, in the event of a shortage of life-saving tools, he wants to have access to it or give way to those who could be more likely to survive . Or «greater value for society». A rule that "imposes unprecedented pressure", concludes Neeman.