RE: Parhar et al.: Ensuring Non-Discrimination in Pandemic Prioritization Decisions
References
. RE: Parhar et al.: Ensuring Non-Discrimination in Pandemic Prioritization Decisions. 2020;:-.
2. Christian MD, Hawryluck L, Wax RS, Cook T, Lazar NM, Herridge MS, et al. Development of a triage protocol for critical care during an influenza pandemic. Canadian Medical Association Journal. 2006 Nov 21;175(11):1377–81.
3. Upshur REG, Faith K, Gibson JL, Thompson AK, Tracy CS, Wilson K, et al. STAND ON GUARD FOR THEE: Ethical considerations in preparedness planning for pandemic influenza. University of Toronto Joint Centre for Bioethics. 2005 Nov pp. 1–29. Available from
We read with great interest the article by Parhar et al. describing triage protocols in Alberta for extracorporeal life support (ECLS) resources, but are concerned that it raises questions by not explicitly mentioning which pre-existing medical conditions would justify exclusion from resources (1).
While we acknowledge that it is reasonable in a pandemic situation to limit access to some intensive resources like ECLS for patients with conditions that limit their chance of survival, these decisions need to be based on predicted patient outcome as judged by the best available evidence, using the most objective criteria possible. They must also be blind to societal factors such as race, religion, or ability to pay. However, in the Canadian context, there is little reason to suspect that those societal factors would be considered by clinicians or systems.
The report from Parhar did not specify which pre-existing medical conditions would quality for exclusion from ECLS (1). Other Canadian reports have gone farther to propose explicitly excluding patients with pre-existing cognitive impairments (2). We contend that co-morbidities that do not influence expected probability to survive, notably pre-existing cognitive or motor disability, should not be factored into triage decisions. If patients have healthy lungs, hearts, and immune systems, there is no medical or ethical reason to bar them from benefitting from resources simply based on cognitive deficit.
There are no recognized legal standards that govern triage in Canada. As suggested by Parhar et al., health care systems should develop policies, to ensure each decision is made in a fair and transparent manner based on objective prognostic factors (3). Any decisions for a specific patient should not rest on an individual clinician.
Individuals with disability, cognitive or otherwise, are human beings, entitled to the same legal and ethical protection as any other person who needs care in Canada.