Dr. Kathy Lofy, the health officer of Washington State, said in an email, “We are very concerned that people believe our scarce resource guidance might discriminate against people with disabilities so we are in the process of setting up time to meet with disability advocacy groups to discuss their concerns.”
“The guidance in Washington around managing scarce resources during emergencies was largely designed to avoid discrimination during the allocation of scarce resource and involves a regional team to ensure resources are being allocated in a fair way,” Dr. Lofy said.
An emailed statement from the Alabama health department said that the state’s ventilator triage guidelines had been “greatly misunderstood” and were “solely intended as a tool for providers” making difficult choices. The statement said the document, which remained on its website on Saturday, was over a decade old and had since been replaced by a more comprehensive set of guidelines for health care emergencies. Those newer guidelines did not address ventilator triage, but said that the allocation of care should not be discriminatory.
Dr. Doug White, who published a proposed framework for rationing critical care in the Journal of the American Medical Association on Friday, said in a webinar that it was important to have “triage guidelines that don’t exclude groups of patients.” He said a score-based approach, endorsed by Pennsylvania, would allow as many patients to be treated as possible, so that “if suddenly 1,000 new ventilators become available, nobody’s sitting without a ventilator.”
Still, some citizen groups who have looked at draft protocols expressed fears that even using predicted survival to determine who would get access to resources — the most common strategy — might be inherently discriminatory.
In a report of a community exercise held in Seattle, some participants said they were concerned that using the likelihood of survival as a rationing criterion was problematic because some groups, such as African-Americans and immigrants, might have poorer health as a result of “institutional racism in the health care system.”
The plans typically include protocols for removing ventilators from people after a certain time period if they do not appear to be improving. In some states, including New York, people who required ventilators long-term, such as those who have certain spinal cord injuries, could be subject to having their ventilators reassigned under the protocol if they were admitted to hospitals during the crisis.
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