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ARCH and AODA Alliance submit Open Letter to government on the need for a non-discriminatory Clinical Triage Protocol

OPEN LETTER: Ontario’s COVID-19 Clinical Triage Protocol
December 3, 2020

To: Hon. Doug Ford, Premier of Ontario
Legislative Building
Queen’s Park
Toronto, ON M7A 1A1
Via email: premier@ontario.ca

Hon. Christine Elliott, Deputy Premier and Minister of Health of Ontario
College Park 5th Floor,
777 Bay Street, Toronto, ON M7A 2J3
Via email: Christine.elliott@ontario.ca

Hon. Raymond Sung Joon Cho, Minister of Seniors and Accessibility of Ontario
Ministry for Seniors and Accessibility
College Park, 5th Floor
777 Bay Street, Toronto, ON M5G 2C8
Via email: Raymond.cho@ontario.ca

Dear Hon. Premier Ford, Hon. Deputy Premier and Minister Elliott, and Hon. Minister Cho:

Re: Ontario’s COVID-19 Clinical Triage Protocol

We write about a life-and-death issue now facing Ontarians over which the Ontario Government has key responsibility. COVID-19 continues to surge, repeatedly breaking prior records for daily new infections. Expert projections show that this surge will continue to get worse, reaching new record infection rates. Our hospitals are being strained to the limit. The risk grows that hospitals may get overwhelmed, with more demand for critical medical care than there are critical care beds, staff and services to meet that demand. If that happens, it would be necessary for there to be “triage” or rationing of critical care. Some patients, needing life-saving critical care, may be refused that care – a publicly-insured medical service covered by OHIP.

Last spring, the Ontario Government sent a March 28, 2020 critical care protocol to all Ontario hospitals, directing how hospitals should decide whom to refuse critical care they need, if triage becomes necessary. The Government did not make public its March 28, 2020 critical care triage protocol, or the fact that it had been sent to Ontario hospitals.

When word of that protocol leaked, an April 8, 2020 open letter to the Ontario Government was sent by over 200 disability organizations and groups, and over 4,800 individuals. It expressed the serious concern that the Government’s March 28, 2020 critical care triage protocol would discriminate against some patients with disabilities. It called for that protocol to be cancelled, and for the Government to consult people with disabilities on this issue.

In response to an opposition question during Question Period in the Legislature on November 5, 2020, the Government revealed that it had cancelled the March 28, 2020 critical care triage protocol. We commend the Government for cancelling it.

However, to our knowledge, the Government has not put in place a replacement for the March 28, 2020 protocol. If critical care triage becomes necessary, decisions over who gets refused life-saving critical care would be wrongly left to individual hospitals and doctors, without safeguards against the serious danger of arbitrary and discriminatory decisions made because of disability.

Last winter, the Ontario Government appointed a “Bioethics Table”, including doctors and bioethicists, to give advice in this area. That Table wrote the March 28, 2020 critical care triage protocol, now cancelled. Last summer, the Bioethics Table held meetings and consultations on this issue, including meetings with some disability advocates and experts.

In mid-September 2020, The Bioethics Table submitted a report to the Ontario Government Ministry of Health, to Ontario Health (part of the Government) and to the Ontario Human Rights Commission. That report made recommendations on how critical care triage should be conducted, to replace the March 28, 2020 triage protocol. The Government has refused to make that report public.

The Bioethics Table itself and the Ontario Human Rights Commission have called on the Government to make public the Bioethics Table’s report and recommendations. The Ontario Human Rights Commission has expressed that the human rights concerns persist with the Bioethics Table’s recommendations.

On November 5, 2020, the Government stated in the Legislature that it “may” provide a new critical care triage framework to health professionals if conditions deteriorate significantly. To continue waiting creates great risk that any new critical care triage framework that discriminates against patients with disabilities cannot be fixed if it becomes too late, and triage is already taking place. It took the disability community over six months to get the discriminatory March 28, 2020 triage protocol withdrawn. Moreover, the COVID-19 situation is now deteriorating significantly, with modelling projecting that it risks quickly getting much worse.

Accordingly, the organizations and groups that are signatories to this open letter call on the Ontario Government to:

  1. Immediately make public the report and recommendations of the Government-appointed Bioethics Table submitted to the Government in mid-September, which are now secret, on how to choose which patients should be refused critical care if the COVID-19 pandemic overwhelms hospitals, requiring triage or rationing of critical care beds and services.
  2. Now hold an open, accessible and inclusive public consultation on how such critical care triage decisions should be made, and what protections for patients must be in place.
  3. Develop and make public any new directives or protocols regarding critical care triage, and ensure that they are primarily guided by, and respect, the constitutional and human rights of all patients, including patients with disabilities, ensure due process to patients that are exposed to the risk of being denied life-saving critical care due to triage or rationing of that care, and that such directives and protocols are founded on a properly mandated legislative foundation.

We urge the Government to act immediately in response to this call for action.

Sincerely,

Accessibility for Ontarians with Disabilities Act Alliance (AODA Alliance)
Accessible Housing Network
Advocacy Centre for the Elderly (ACE)
Alliance for Equality of Blind Canadians/l’Alliance pour l’Égalité des Personnes Aveugles du Canada
ARCH Disability Law Centre
Barrier-Free Canada/Canada Sans Barrieres (BFC/CSB)
B.C. Aboriginal Network on Disability Society
Bellwoods Centres for Community Living Inc
Breaking Down Barriers Independent Living Resource Centre
Brockville and District Association for Community Involvement
Canadian Autism Spectrum Disorder Alliance
Canadian Down Syndrome Society
Centre for Independent Living in Toronto (CILT)
Chatham-Kent Legal Clinic
Citizens With Disabilities – Ontario (CWDO)
CNIB Foundation
Communication Disabilities Access Canada
Community Living Chatham-Kent
Community Living Ontario
Community Living Prince Edward
Council of Canadians With Disabilities
DeafBlind Ontario Services
DEEN Support Services
Durham Association for Family Resources and Support
Empowered Kids Ontario
Family Network Thames Valley
Family Support Network-York region
Good Things In Life
Guelph Independent Living
Guide Dog Users of Canada
Hamilton Community Legal Clinic/Clinique juridique communautaire de Hamilton
HIV & AIDS Legal Clinic Ontario
HIV Legal Network
Hydrocephalus Canada
Inclusion Canada
Independent Living Canada
Injured Workers Community Legal Clinic
Joyce Scott Non Profit Homes Inc.
Lupus Canada
March of Dimes Canada
MPN Ontario Patient Support Group
Muscular Dystrophy Canada
National Coalition of People who use Guide and Service Dogs
National Network for Mental Health
Network of Women with Disabilities NOW
Ontario Association of the Deaf
Ontario Disability Coalition
Ontario Federation for Cerebral Palsy
Ontario Parents of Visually Impaired Children OPVIC (Also known as Views for the Visually Impaired)
OPTIONS NORTHWEST
Organization of Canadian Tamils with Disabilities
Parents of Adults with Developmental Disabilities
Peterborough Community Legal Centre
PHSS – Medical and Complex Care in Community
PooranLaw Professional Corporation
RISE: Resource Centre for Independent Living
Shannon law office
Spinal Cord Injury Ontario
Sudbury Community Legal Clinic
Susan Morris Consulting Inc
Tangled Art + Disability
The Older Women’s Network
The Ontario Autism Coalition
Working for Change



Last Modified: December 3, 2020

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