@CMA_Docs comes out with utilitarian "Framework for Ethical Decisionmaking During the Coronavirus Pandemic" embracing considerations of 'length of life' remaining, seemingly deprioritizing elderly & people w disabilities or chronic illness (1) https://policybase.cma.ca/en/viewer?file=%2fdocuments%2fPolicypdf%2fPD20-03.pdf#search=&phrase=false

(2) As excuse for largely taking over recommendations & text NEJM article, @CMA_Docs suggests it looked at "documents, reports and policies produced by our Italian colleagues and ethicists and physicians from Canada & around the world, as well as provincial level frameworks"

(3) with its excuses for not holding any "deliberations and consultations with numerous stakeholders, including patients and the public". As if there is no other option than to consult for 'months' ...

(4) Procedurally, @CMA_Docs recommends triage committees, indeed a good thing; but unfortunately no mention of why this may help avoiding ableist, ageist & idiosyncratic individual judgment; only recommended to "lessen the moral burden being placed on the individual physician"

(5) with emphasis on need for "legal protection to ensure that doctors can continue providing needed care...without fear of civil or criminal liability or professional discipline". Fine to ask for reassurance in extremely stressful context for health care providers; but ...

(6) @CMAJ should better make sure then first that its recommendations are in line with legal norms, including norms of consent to withdrawal of ventilator (e.g. Rasouli SCC) & human rights law (discrimination on basis of disabiilty, age, health, ... )

(7) Some of us criticized components of Ontario draft triage guidelines. Well, @CMA_Docs 'framework' is much more bluntly utilitarian, but vagueness makes it harder to exactly say how it would be applied (more general recommendations)

(8) Framework all too easily hides behind pseudo-"consensus" "Saving more lives and more YEARS OF LIFE is a consensus value across expert reports". Really?

(9) 'Years of life' focus appears discriminatory towards elderly & many people with disabilities & chronic illness

(10) Prioritizing "critical care workers" for ICU care would, in order to be reasonable, require some evidence that this is/will be essential to maintain sufficient health care forces. Otherwise likely unjustifiable discrimination

(11) @CMA_Docs states: "[p]riority for critical workers must not be abused by prioritizing wealthy or famous persons or the politically powerful above first responders and medical staff" as this would "undermine public trust". What about: it would be highly unethical & illegal?

(12) Is this now the professional ethics approach @CMA_Docs : basic utilitarianism? Even in pandemic, other ethical values and legal norms require attention

@CACL_ACIC @ARCHDisability @LawDisabilitySC @DrNancyHansen @DAWNRAFHCanada @aodaalliance @CatherineFrazee @KristaCarrNB @jodyRcarr @DavidLepofsky