How to value lives in the coronavirus pandemic – opinion

A life is a life. Can the Israeli healthcare system put that value into action?

By JAY RUDERMAN
A ventilator is seen at the New York City Emergency Management Warehouse (photo credit: REUTERS)
A ventilator is seen at the New York City Emergency Management Warehouse
(photo credit: REUTERS)
Who lives and who dies? It is the jarring judgment call made far too often in hospitals during the COVID-19 pandemic due to the unprecedented strain on the healthcare system.
In Israel, it was recently revealed that the Health Ministry’s official Ethics Committee recommended guidelines for hospitals to prioritize the lives of able-bodied people over those with disabilities should there have been any shortages in the limited access of life-saving ventilators. Due to public pressure, the guidelines for triage were updated but remain discriminatory toward people with physical disabilities, including those with limited mobility and reduced work capacity.
Link20, a social justice movement initiated by the Ruderman Family Foundation, advocated for these recommendations to be changed and met with the committee to promote change. However, the gaps remain and any decision is now in the hands of Health Minister Yuli Edelstein.
These challenges, of course, are not unique to Israel. Several US states have been accused of discriminatory practices on the treatment of people with disabilities, including in regard to the rationing of ventilators.
Washington state recommends transferring patients with “loss of reserves in energy, physical ability, cognition and general health” out of hospitals and into outpatient care. Alabama recently reached a resolution with the Office of Civil Rights at the US Department of Health and Human Services to remove the state’s discriminatory ventilator guidelines, in which people with “severe or profound mental retardation” or “moderate to severe dementia” had been deemed “unlikely candidates for ventilator support.”
Further, Massachusetts had released guidelines to determine who would receive a ventilator or ICU bed if one person’s life had to be prioritized over another during the pandemic. The Disability Policy Consortium, which is led by Link20 Leadership Program alum Colin Killick, brought together 14 disability rights and public health groups to spearhead a letter to Massachusetts policy-makers that urged them to help change the inequitable guidelines – and indeed, the state revised them in mid-April.
Against the backdrop of these developments, the Ruderman Family Foundation recently published a white paper, “Fair Resource Allocation During the COVID-19 Pandemic,” which calls for the implementation of more objective triage guidelines which can take into account the plight of vulnerable populations and avoid discriminatory procedures. The report recommends that medical facilities navigate an increasingly complex bioethical landscape by appointing a triage team tasked with making decisions about who will be prioritized to receive critical care based on clinical data for each patient, aiming to use resources in a way that maximizes patient survival.
The study also analyzes the landscape surrounding people with disabilities and disaster medicine, attending to patients with disabilities who have medical conditions other than COVID-19 and visitation in hospitals and residential facilities.
“It may become tempting to prioritize the needs of patients with COVID-19 over others who are critically ill due to other illnesses or trauma,” the authors explain. “However, favoring COVID-19 patients—simply on the basis of COVID-19—over patients with other conditions who may also need critical care would be arbitrary and unjust. Individuals with disabilities who experience non-COVID-19 medical emergencies should receive the standard of care or equivalent and they should be assured that disruptions or shifts in treatment are not pegged to a subjective evaluation of their quality of life.”
A life is a life. While medical personnel may need to make very difficult decisions during triage situations, any country and its medical system should not put a higher value on able-bodied patients over others. By doing so, we will devalue ourselves as a society based on equal rights for all. It is our responsibility to care for all regardless of preconceived notions about the value of the lives of people with compromised situations; by doing so, we will elevate ourselves as societies.
The pandemic has laid bare the various disparities and injustices that still occur in society for people with disabilities, including in regard to gaps in access to lifesaving medical care. This situation is nothing new, nor is it unique to the COVID-19 crisis. Rather, these longstanding and fundamental inequities are under unprecedented scrutiny which should inspire unprecedented action to address them.
We must use the pandemic era as an opportunity to end discrimination against people with disabilities, once and for all, in Israel, the US and the world over.
The writer is president of the Ruderman Family Foundation.


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