Draft @ONThealth triage doc re COVID-19 claims to embrace utility, proportionality & fairness as guiding principles @jyangstar reports. But what notion of 'fairness' remains illusive, so I point out. @UTLaw @UofT_dlsph (1) https://www.thestar.com/news/canada/2020/03/29/ontario-developing-last-resort-guidelines-on-which-patients-to-prioritize-if-hospitals-are-overwhelmed-by-critical-covid-19-cases.html

(2) v Important to have practical & transparent basis for triage decision making, so positive to have guidance document. But ethical principles should not be used to back up decisions which are presented as clinical & value neutral when they are not

(3) Fairness in document appears to be a formalistic equality. Doc should explicitly refer to need to avoid discrimination on basis of disability & ensure pre-existing inequities are not augmented. Fairness could indeed be seen as requiring effort to do the opposite.

(4) need to ensure ableist presumptions quality of life of p w disabilities are avoided. Decisions will be made in situations of profound uncertainty re risk & outcome. Ableist presumptions will seep into triage decision process that relies e.g. on levels of frailty & dependence

(5) recommendation to potentially disconnect in situation of scarcity person w significant chance of survival from support because other person arrives w higher statistical chance seems ethically & legally problematic & practically unsustainable

(6) Good to see explicit reference to need to offer further palliative care & comfort measures of those whose health situation no longer justifies use of respirator

(7) and overall also positive to see development of basic protocol for decision making that involves interdisciplinary team

(8)human rights based recommendations International Disability Alliance: a reminder that ON draft triage policy should not deprioritize (also not de facto) on basis of disability

(9) Other key recommendations re COVID19 public health measures re need to accommodate

(10) full set of recommendations International Disability Alliance here @ONThealth @CMAJ @DocSandyB @AmitAryaMD @jamesdownar @brunogagnon12 @Thomsod @SheilaKJennings @CACL_ACIC @ARCHDisability http://www.internationaldisabilityalliance.org/sites/default/files/ida_recommendations_for_disability-inclusive_covid19_response_final.pdf