Submission – Open Letter: Ontario’s COVID-19 Triage Protocol
April 8, 2020
Hon. Doug Ford, Premier of Ontario
Legislative Building
Queen’s Park
Toronto, ON M7A 1A1
Hon. Christine Elliott, Deputy Premier and Minister of Health of Ontario
College Park 5th Floor,
777 Bay Street, Toronto, ON M7A 2J3
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
Dear Hon. Premier Ford, Hon. Deputy Premier and Minister Elliott, and Hon. Minister Cho:
Re: Ontario’s Clinical Triage Protocol
We, the undersigned, share grave concerns regarding Ontario Health’s Clinical Triage Protocol for Major Surge in COVID Pandemic, dated March 28, 2020, which has yet to be released to the public. As disability organizations, we write in particular to underscore the disproportionate and adverse impact that the Triage Protocol will have on people with disabilities, and to make recommendations for reform.
The COVID-19 pandemic is disproportionately impacting persons with disabilities: our communities are more vulnerable to the virus and are being severely impacted by the necessary emergency response measures, like physical distancing, which interferes with the supports they need for daily living or is not altogether possible.
The Triage Protocol must respect the human rights of all persons, including persons with disabilities. Consultation with human rights experts and the marginalized communities of persons who are going to be disproportionately impacted by the Triage Protocol, must be conducted. Even though it is an emergency situation, the COVID-19 pandemic cannot be used as justification for discrimination.
To this end, we make the following specific recommendations:
(1) Persons with disabilities cannot be deprioritized for critical care on the basis of their disability
According to the Triage Protocol, some people will not get critical care because of their disability. For example, the Triage Protocol identifies particular disabilities, such as cognitive disabilities and advanced neurodegenerative diseases including Parkinson Disease, and Amyotrophic Lateral Sclerosis. Persons with these disabilities may in some stages of their disability be deprioritized in determinations about who receives critical care.
It is imperative that decisions about who receives critical care should be made using objective clinical criteria directly associated with mortality risks of COVID-19, and must not be based on stereotypes or assumptions about a person’s disability, and longer term mortality rates that are not directly related to COVID-19. It should also be made clear that by virtue of someone’s disability, they will not be deemed a lower priority and passed over for another patient who does not have a disability.
(2) The Triage Protocol must clearly state that clinical judgment must not be informed by bias, stereotypes, or ableism
The Triage Protocol explicitly states that clinical assessments cannot take into consideration a patient’s socioeconomic privilege or political rank. As the health-care system has a long-entrenched history of ableism, the Triage Protocol must also explicitly state that implicit disability-based bias, stereotypes and ableist assumptions cannot factor into clinical judgment or assessment when allocating critical care resources. It must also make clear that decisions cannot be made on the basis of human-rights protected characteristics and intersecting identities. We understand that clinical judgment is an important part of the Triage Protocol, but there must be necessary safeguards to ensure that particular marginalized groups are not adversely impacted.
(3) Persons with disabilities cannot be deprioritized for critical care based on the supports they receive for daily living
According to the Triage Protocol, persons with disabilities who receive accommodations or supports from others for daily living are in some circumstances less likely to receive critical care. This means that the Triage Protocol has the effect of deeming the lives of persons who require assistance as being less worthy, or assumes that they have a lesser quality of life. These kinds of criteria are discriminatory and devalue the lives of persons with disabilities. The Protocol invites value-based judgments on the basis of disability-related accommodations, which are a basic human right.
(4) The Triage Protocol must clearly ensure that persons with disabilities receive necessary disability-related accommodations
The Triage Protocol does not have a clear statement that persons will receive necessary disability-related accommodations in the implementation of the Triage Protocol. Accommodations, such as interpretation, support or other services to access medical services, are a basic tenet of human rights law. Disability-related accommodations ensure that persons with disabilities have equal opportunity to receive, understand, and benefit from critical care.
We understand and appreciate that health care workers are working hard to care for all Ontarians, and a practical framework is required to help them make very difficult decisions about who gets critical care with some level of efficiency. We therefore support the development of a policy that respects human rights and has a fair procedure of decision making. We ask that any such framework not violate the basic human rights of persons with disabilities. The rationing of scarce resources in the health care system during this health crisis cannot be used as justification for discrimination.
Sincerely,
This letter has been signed by 204 organizations and 4828 individuals, as follows:
Organizations
- ARCH Disability Law Centre
- Access Independent Living Services
- Accessibility for All
- ACCKWA – AIDS Committee of Cambridge, Kitchener, Waterloo & Area
- Advocacy Centre for the Elderly
- AIDS ACTION NOW!
- AIDS Committee of Windsor
- ALS Society of Canada
- Alzheimer Society Durham Region
- Alzheimer Society Lanark Leeds Grenville
- Alzheimer Society of Niagara Region
- Alzheimer Society of Perth County
- Alzheimer Society Timmins-Porcupine
- Alzheimer Society Waterloo Wellington
- AODA Alliance
- Arthritis Society
- Autism Ontario
- Balance for Blind Adults
- BarrierFree Saskatchewan
- BC Aboriginal Network on Disability Society
- Brockville and District Association for Community Involvement (BDACI)
- Bellwoods Centres for Community Living
- Black Coalition for AIDS Prevention
- Black Legal Action Centre
- Bob Rumball Canadian Centre of Excellence for the Deaf
- Brampton Caledon Community Living
- Breaking Down Barriers Independent Living Resource Centre
- Bridges to Belonging
- Brockville & Area Community Living Association
- Camp Bowen Society for the Independence of the Blind and Deafblind
- Canadian Association for Community Living
- Canadian Autism Spectrum Disorder Alliance
- Canadian Council on Rehabilitation and Work
- Canadian Down Syndrome Society
- Canadian Federation of the Blind of Ontario
- Canadian Hard of Hearing Association
- Canadian HIV/AIDS Legal Network
- Centre for Independent Living in Toronto (CILT)
- Chatham-Kent Legal Clinic
- Chinese & Southeast Asian Legal Clinic
- Christian Horizons
- Citizen Advocacy Ottawa
- Citizens With Disabilities – Ontario (CWDO)
- Community Living Ajax – Pickering and Whitby
- CNIB Foundation
- Cochrane Temiskaming Resource Centre
- Communication Disabilities Access Canada
- Community Autism Centre Inc.
- Community Living Ajax Pickering and Whitby
- Community Living Algoma
- Community Living Campbellford/ Brighton
- Community Living Central York
- Community Living Chatham-Kent
- Community Living Dundas County
- Community Living Essex County
- Community Living Guelph Wellington
- Community Living Kincardine & District
- Community Living Kingston & District
- Community Living North Bay
- Community Living North Grenville
- Community Living Ontario
- Community Living Prince Edward
- Community Living Quinte West
- Community Living Toronto
- Community Living Upper Ottawa Valley
- Community Living Welland-Pelham
- Community Living West Nipissing
- Community living Windsor
- Community Living York South
- Community Living-Central Huron
- Community Resistance Intimacy Project (CRIP)
- Council of Canadians with Disabilities (CCD)
- Council of Canadians, Peterborough and Kawarthas chapter
- DANI
- Deafblind Community Services
- DEEN Support Services
- Disability Alliance BC
- Disability Justice Network of Ontario (DJNO)
- DisAbled Women’s Network Canada (DAWN)
- Dissociative Society of Canada
- Down Syndrome Association of Peel
- Down Syndrome Association of Toronto
- Down Syndrome Caring Parents of Niagara
- Down Syndrome Niagara
- Downsview Community Legal Services
- Durham Association for Family Resources and Support
- Durham Family Network
- Easter Seals Ontario
- Elevate NWO
- Empower Simcoe
- Empowered Kids Ontario – Enfants Avenir Ontario
- ensemble
- Erich’s Cupboard
- Ethno Racialized Disability Coalition Ontario (ERDCO)
- Extend-A-Family
- Extend-A-Family Waterloo Region
- Facile Perth
- Families for a Secure Future
- Family Alliance Ontario
- Family Respite Services
- Family Support Network for Employment
- Family Support Network (Newmarket/Aurora)
- Family Support Network (Total Communication Environment)
- Fetal Alcohol Spectrum Disorder Group of Ottawa
- Good Things In Life
- Guelph Independent Living
- Guide Dog Users of Canada
- Hamilton & District Injured Workers Group
- Hamilton Community Legal Clinic
- Hamilton Family Network
- Hand Over Hand Community Organization
- HIV & AIDS Legal Clinic Ontario (HALCO)
- Hydrocephalus Canada
- Independent Living Centre of Waterloo Region
- Inclusive Design Research Centre, OCAD University
- Income Security Advocacy Centre (ISAC)
- Independent Living Canada
- Independent Living Centre London and Area
- Injured Workers Community Legal Clinic (IWC)
- Intensive TLC
- Joyce Scott Non Profit Homes Inc.
- Kawartha Sexual Assault Centre
- KMK Law
- KW AccessAbility
- KW habilitation
- Lake Country Community Legal Clinic
- L’Arche Canada
- L’Arche Daybreak
- L’Arche London
- L’Arche Sudbury
- Live & Learn Centre
- London Down Syndrome Association
- March of Dimes Canada
- Marsha Forest Centre
- Mary Centre of the Archdiocese of Toronto
- Member Family Support Network TCE
- Middlesex Community Living
- Millennial Womxn in Policy
- Montage Support Services
- MPN Ontario Patient Support Group
- Muscular Dystrophy Canada
- National Coalition of People who use Guide and Service Dogs
- National Educational Association of Disabled Students (NEADS)
- National Network for Mental Health (NNMH)
- Network of Women with Disabilities NOW
- New Vision Advocates
- No More Silence
- Older Women’s Network / Living in Place Campaign
- Ontario Association for Developmental Education
- Ontario Association of Independent Living Service Providers
- Ontario Association of the Deaf
- Ontario Autism Coalition
- Ontario Disability Coalition
- Ontario Federation for Cerebral Palsy
- Ontario Health Coalition
- Ontario Independent Facilitation Network
- Options Northwest Personal Support Services
- Ontario Parents of Visually Impaired Children – VIEWS for the Visually Impaired
- Ottawa Carleton Association for Persons with Developmental Disabilities
- Ottawa Independent Living Resource Centre
- P.A.D.D. Parents of Adults who have Developmental Disabilities
- PACE Independent Living
- Pacific Training Centre for the Blind
- Parkdale Community Legal Services
- Parkdale People’s Economy
- Participation Lodge Grey-Bruce
- Peterborough Community Legal Centre
- Peterborough Health Coalition
- PHSS-Medical & Complex Care in Community
- PooranLaw Professional Corporation
- Prisoners with HIV/AIDS Support Action Network
- Project 321 Peel Down Syndrome Association
- Project Autism
- PWA (Toronto People With AIDS Foundation)
- Realize
- RISE: Resource Centre for Independent Living
- Scleroderma Society of Ontario
- Shannon Law Office
- Students for Barrier-free Access
- Sudbury Community Legal Clinic
- Tangled Art + Disability
- The AIDS Committee of Durham Region
- The AIDS Network
- The Canadian Arthritis Patient Alliance
- The FASD E.L.M.O. Network
- The George Hull Centre for Children and Families
- The Legal Clinic (Perth, Sharbot Lake, Brockville)
- The Neighbourhood Group
- The Organization of Canadian Tamils With Disabilities (OCTD)
- The Participation House Project, Durham Region
- Toronto Family Network
- Toronto Yachad – The Canadian Jewish Council for Disabilities
- Total Communication Environment
- Traverse Independence
- Universities Allied for Essential Medicines (UAEM)
- Viability Employment Services
- Vibrant Health Care Alliance
- Vision Loss Rehabilitation Ontario
- Waterloo Regional Down Syndrome Society (WRDSS)
- Windsor-Essex Family Network
- Workers United Canada Council
- Working For Change
- York Region Lifetime Independent Facilitation
- YWCA Hamilton
Joel Harden MPP, on behalf of the Ontario NDP caucus
The original letter sent to the above noted recipients included a full list of individual signatories.