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From the University of Washington Medical Center resource allocation guidelines in response to COVID-19: covid-19.uwmedicine.org/Screening%20an…

#CripTheVote
We are likely to very shortly see rationing decisions with regard to scarce medical resources, especially ventilators. It is essential that we raise our voices now to ensure that this rationing does not discriminate on the basis of disability. #CripTheVote
In Italy, we are already seeing such discrimination. Some are pushing for American hospitals to adopt similar measures. washingtonpost.com/health/2020/03… #CripTheVote
With respect to the UW Medical Center allocation principles, it's interesting to note that they largely ignore the existence of non-elderly disabled people. #CripTheVote
This is an important oversight, as it makes it easier to conflate two very different rationing decisions: prioritizing the young over the old, as opposed to prioritizing the non-disabled over the disabled. #CripTheVote
While UW is likely correct that prioritizing the young over the old has "general support" in society-at-large, that is not necessarily the case for prioritizing the non-disabled over the non-elderly disabled. #CripTheVote
There's some preliminary information that suggests that underlying disabilities reduce COVID-19 survival probabilities even after controlling for age (though we don't really know enough to be sure yet). #CripTheVote
This is going to be increasingly relevant, as many state allocation procedures explicitly allow for excluding disabled people from critical care. #CripTheVote
This typically focuses primarily on end-of-life conditions, but does often allow the exclusion of the non-elderly disabled from scarce life-sustaining medical resources as well. #CripTheVote
For example, Tennessee's triage tools permit the exclusion from critical care of people with SMA who require ADL or ventilator assistance. tn.gov/content/dam/tn… Triage Tools and Tables<br />
(a) EXCLUSION CRITERIA for Hospital<br />
Admission:<br />
The patient is excluded from admission or transfer to<br />
critical care if ANY of the following is present:7. Advanced untreatable neuromuscular disease<br />
(such as ALS, end-stage MS, spinal muscular atrophy)<br />
requiring assistance with activities of daily living or<br />
requiring chronic ventilatory support.
Alabama's Criteria for Mechanical Ventilator Triage classifies "persons with severe or profound mental retardation" alongside those in a persistent vegetative state as "unlikely candidates for ventilator support". adph.org/CEP/assets/VEN… #CripTheVote
New York State allocation guidelines allow hospitals to take away ventilators from disabled people who come into the hospital from an LTSS setting in which they typically have ventilator access. #CripTheVote The Task Force reaffirmed that chronic care patients are only subject to the Guidelines<br />
when they arrive at an acute care facility. With their arrival at the hospital, they are treated like<br />
any other patient who requires a ventilator and need to meet certain criteria to be eligible for<br />
ventilator therapy.<br />
 While a policy to triage upon arrival may deter chronic care patients from<br />
going to an acute care facility for
This creates an obvious incentive problem - chronic vent users can keep their vents if they stay out of the hospital, but may have them taken away due to rationing if they come to the hospital, resulting in likely death. health.ny.gov/regulations/ta… #CripTheVote Allowing sick patients to remain in long-term care facilities as an alternative to<br />
transfer may increase the burden on these facilities. However, it is appropriate for the health care<br />
providers at these facilities to balance the burdens of treating an acute condition against the risk<br />
of a patient losing access to the ventilator upon transfer, and act accordingly
This means that infected chronic vent users in nursing homes, group homes and community settings have a strong incentive NOT to seek hospital care. #CripTheVote
That is the exact opposite of what we should be doing to preserve health and safety in these settings during a pandemic. #CripTheVote
There is a great deal of work to be done protecting people with disabilities from disability discrimination in the allocation of scarce medical resources, and that work needs to take place RIGHT NOW. #CripTheVote
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