Here's a scary thread.
HT @kedwardbear who sent it to me.
Now, I'll tell you why I find it particularly scary in Australia....
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HT @kedwardbear who sent it to me.
Now, I'll tell you why I find it particularly scary in Australia....
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@kedwardbear This thread is all about setting criteria for access to intensive care in an overwhelmed health system. It's happening in Italy. That is scary enough. But there's a but....
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@kedwardbear Criteria for this sort of thing make it feel like objective decisions are being made. But they always carry values with them, which we need to name...
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@kedwardbear One of the criteria, of course is multimorbidity. And the reasoning is sound.
Except who has the most multimorbidity at a younger age? Aboriginal and Torres Strait Islander people. And people without money. (There is a lot of crossover)
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Except who has the most multimorbidity at a younger age? Aboriginal and Torres Strait Islander people. And people without money. (There is a lot of crossover)
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@kedwardbear So, if we have to ration ICU, I will bet that less well off people, and Aboriginal and Torres Strait Islander people will have less access to ICU.
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@kedwardbear How do I know? Because this is the way the health system *already* operates.
Check out, say, access to renal transplants.
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Check out, say, access to renal transplants.
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@kedwardbear As an aside, value judgements always seem to make their way in to "objective" criteria like this, and we make decisions that favour "people like us" - well off, middle class, with agency - over people we might like less - people with addictions, say, or prisoners.
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@kedwardbear I'll let @bluntshovels comment on the likely outcomes of this for disabled people, should it happen here.
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@kedwardbear @bluntshovels It's not a huge step, then, to deny ICU care to people who smoke, or people who are overweight. Just because the outcomes won't be as good. Of course, of course.
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@kedwardbear @bluntshovels These are horrible decisions to have to make. But if we go at them with a human rights lens, rather than a utilitarian/consequential lens we maybe should feel even more uncomfortable.
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@kedwardbear @bluntshovels The good news, is that this is not inevitable.
But...
We only get equity if we aim for it.
Otherwise we do business as usual.
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But...
We only get equity if we aim for it.
Otherwise we do business as usual.
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@kedwardbear @bluntshovels So I think it's really important that we flatten that curve, that we slow the spread to allow health services not to be overwhelmed. And perhaps we try to create as much health service capacity as possible.
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@kedwardbear @bluntshovels That means that washing out hands, social isolation, looking out for each other is a health equity action!
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@kedwardbear @bluntshovels And if the health service gets overwhelmed, I suspect we will have to make these decisions, and I suspect they will increase health inequities, and cause extra grief and trauma for communities already vulnerable.
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