Quebec must explain which COVID-19 patients get priority before second wave: disability advocates
MONTREAL -- Now that there’s a decrease—or perhaps just a lull—in coronavirus cases in Quebec, advocates for people with disabilities want the province to release a document it has so far refused to make public: its triage protocol for COVID-19 patients.
This set of rules lays out how the provincial health-care system will decide which coronavirus patients will take priority if resources become scarce.
It will give doctors a guide, for example, in the event that they have just one lifesaving ventilator available but two patients who need it.
The rules “will kick in if we get to a situation where the pandemic is out of control,” says Vardit Ravitsky, a bioethicist and professor at the Université de Montreal.
It is unavoidable that there must be some set of guidelines like this, since pandemics can easily overwhelm medical resources.
However, the details of what’s in the protocol for each province or state are not a given—and people like Ravitsky would like to know what’s in Quebec’s, ideally before any potential second wave of the virus arrives.
The goal in these triage protocols is to maximize the lives saved. A patient’s health would be the first deciding factor—patients who are struggling more from the virus, with less chance of fighting it off, would be lower priority than someone with a better chance of being saved.
“People with a lower chance of survival will be on a lower priority,” says Ravitsky.
But if their chances of survival are equal, there are other sets of factors that can then be weighed.
One of the criteria, Ravitsky says, is that a “severe cognitive impairment due to progressive illness” can be taken into account, such as advanced Alzheimer’s.
However, for doctors in a moment of crisis, it could be that type of logic “opens the door” to de-prioritizing someone with another cognitive disability, like from childhood Down syndrome or “very severe autism,” she says.
Ravitsky says that when Quebec’s protocols were developed, there were a few patient advocates involved but no one speaking for people with disabilities.
She said she understands why the process was rushed at first, but Quebec now has a bit of breathing room to revisit it.
“In a situation of crisis, you can’t have ideal conditions and have a broad public consultation,” she said.
But “now that we have it and we’re not using it, we have the time to consult the public.”
So far, people asking to see the protocol have been told to file an access to information request, a formal process that can take months to produce a document.
Ravitsky said that approach diminishes public trust.
“Now that the protocol exists, there is no reason to hide it from the public. It needs to be communicated, it needs to be presented by the government in a transparent way,” she said.
“If we’re going to ask the public to stay home, social distance, wear a mask…we must maintain public trust.”