Abstract
During disasters, when resources and care are scarce, healthcare workers are required to make decisions and prioritise which patients receive life-saving resources over others. To assist healthcare workers in standardising resources and care, triage policies have been developed. However, the current COVID-19 triage policies and practices in South Africa may exclude or disadvantage many disabled people, especially people with physical and intellectual impairments, from gaining intensive care unit (ICU) access and receiving ventilators if becoming ill. The exclusion of disabled people goes against the principles established in South Africa’s Constitution, in which all people are regarded as equal, have the right to life and inherent dignity, the right to access healthcare, as well as the protection of dignity. In addition, the triage policy contravenes the United Nations Convention on the Rights of Persons with Disabilities, which the South African government has signed and ratified. This article raises debates about whose lives matter and whose lives are ‘worth’ saving over others, and although the focus is on South Africa, the issues may be relevant to other countries where life-saving resources are being rationed.
Highlights
Disabled people experience discrimination and hardship in all spheres of life, including employment, education and access to healthcare
We provide a rapid review of the key issues emerging in discussions about COVID and disability and discuss their relevance for triage and other procedures in South Africa
Before we turn to the South African case, we review key issues about COVID and disability that are currently being discussed
Summary
Disabled people experience discrimination and hardship in all spheres of life, including employment, education and access to healthcare. The triage policy Allocation of Scarce Critical Care Resources during the COVID-19 Public Health Emergency in South Africa is based on the principles of ‘saving the most lives’ and ‘saving the most life years’ It uses the Clinical Frailty Scale, which includes a scale from 1 to 9, with 1 being those who are very fit and 9 including people who are terminally ill (from other causes) and approaching the end of life (CCSSA 2020a). They believe that the issue of prognosis (and the implicit key question of whether a patient is likely to benefit from care interventions) is not sufficiently addressed and remains ‘completely subjective, without any regard to an evidence-based decision making process’ (SADA 2020:3) They further state that the use of the Clinical Frailty Scale does not take into account people with disabilities who may http://www.ajod.org have a life expectancy equal to that of an able-bodied person, be very fit and yet be classified as severely frail because of a physical impairment. Currently no feedback has been given from the ministry
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