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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

  1. ARCH Disability Law Centre
  2. Access Independent Living Services
  3. Accessibility for All
  4. ACCKWA – AIDS Committee of Cambridge, Kitchener, Waterloo & Area
  5. Advocacy Centre for the Elderly
  6. AIDS ACTION NOW!
  7. AIDS Committee of Windsor
  8. ALS Society of Canada
  9. Alzheimer Society Durham Region
  10. Alzheimer Society Lanark Leeds Grenville
  11. Alzheimer Society of Niagara Region
  12. Alzheimer Society of Perth County
  13. Alzheimer Society Timmins-Porcupine
  14. Alzheimer Society Waterloo Wellington
  15. AODA Alliance
  16. Arthritis Society
  17. Autism Ontario
  18. Balance for Blind Adults
  19. BarrierFree Saskatchewan
  20. BC Aboriginal Network on Disability Society
  21. Brockville and District Association for Community Involvement (BDACI)
  22. Bellwoods Centres for Community Living
  23. Black Coalition for AIDS Prevention
  24. Black Legal Action Centre
  25. Bob Rumball Canadian Centre of Excellence for the Deaf
  26. Brampton Caledon Community Living
  27. Breaking Down Barriers Independent Living Resource Centre
  28. Bridges to Belonging
  29. Brockville & Area Community Living Association
  30. Camp Bowen Society for the Independence of the Blind and Deafblind
  31. Canadian Association for Community Living
  32. Canadian Autism Spectrum Disorder Alliance
  33. Canadian Council on Rehabilitation and Work
  34. Canadian Down Syndrome Society
  35. Canadian Federation of the Blind of Ontario
  36. Canadian Hard of Hearing Association
  37. Canadian HIV/AIDS Legal Network
  38. Centre for Independent Living in Toronto (CILT)
  39. Chatham-Kent Legal Clinic
  40. Chinese & Southeast Asian Legal Clinic
  41. Christian Horizons
  42. Citizen Advocacy Ottawa
  43. Citizens With Disabilities – Ontario (CWDO)
  44. Community Living Ajax – Pickering and Whitby
  45. CNIB Foundation
  46. Cochrane Temiskaming Resource Centre
  47. Communication Disabilities Access Canada
  48. Community Autism Centre Inc.
  49. Community Living Ajax Pickering and Whitby
  50. Community Living Algoma
  51. Community Living Campbellford/ Brighton
  52. Community Living Central York
  53. Community Living Chatham-Kent
  54. Community Living Dundas County
  55. Community Living Essex County
  56. Community Living Guelph Wellington
  57. Community Living Kincardine & District
  58. Community Living Kingston & District
  59. Community Living North Bay
  60. Community Living North Grenville
  61. Community Living Ontario
  62. Community Living Prince Edward
  63. Community Living Quinte West
  64. Community Living Toronto
  65. Community Living Upper Ottawa Valley
  66. Community Living Welland-Pelham
  67. Community Living West Nipissing
  68. Community living Windsor
  69. Community Living York South
  70. Community Living-Central Huron
  71. Community Resistance Intimacy Project (CRIP)
  72. Council of Canadians with Disabilities (CCD)
  73. Council of Canadians, Peterborough and Kawarthas chapter
  74. DANI
  75. Deafblind Community Services
  76. DEEN Support Services
  77. Disability Alliance BC
  78. Disability Justice Network of Ontario (DJNO)
  79. DisAbled Women’s Network Canada (DAWN)
  80. Dissociative Society of Canada
  81. Down Syndrome Association of Peel
  82. Down Syndrome Association of Toronto
  83. Down Syndrome Caring Parents of Niagara
  84. Down Syndrome Niagara
  85. Downsview Community Legal Services
  86. Durham Association for Family Resources and Support
  87. Durham Family Network
  88. Easter Seals Ontario
  89. Elevate NWO
  90. Empower Simcoe
  91. Empowered Kids Ontario – Enfants Avenir Ontario
  92. ensemble
  93. Erich’s Cupboard
  94. Ethno Racialized Disability Coalition Ontario (ERDCO)
  95. Extend-A-Family
  96. Extend-A-Family Waterloo Region
  97. Facile Perth
  98. Families for a Secure Future
  99. Family Alliance Ontario
  100. Family Respite Services
  101. Family Support Network for Employment
  102. Family Support Network (Newmarket/Aurora)
  103. Family Support Network (Total Communication Environment)
  104. Fetal Alcohol Spectrum Disorder Group of Ottawa
  105. Good Things In Life
  106. Guelph Independent Living
  107. Guide Dog Users of Canada
  108. Hamilton & District Injured Workers Group
  109. Hamilton Community Legal Clinic
  110. Hamilton Family Network
  111. Hand Over Hand Community Organization
  112. HIV & AIDS Legal Clinic Ontario (HALCO)
  113. Hydrocephalus Canada
  114. Independent Living Centre of Waterloo Region
  115. Inclusive Design Research Centre, OCAD University
  116. Income Security Advocacy Centre (ISAC)
  117. Independent Living Canada
  118. Independent Living Centre London and Area
  119. Injured Workers Community Legal Clinic (IWC)
  120. Intensive TLC
  121. Joyce Scott Non Profit Homes Inc.
  122. Kawartha Sexual Assault Centre
  123. KMK Law
  124. KW AccessAbility
  125. KW habilitation
  126. Lake Country Community Legal Clinic
  127. L’Arche Canada
  128. L’Arche Daybreak
  129. L’Arche London
  130. L’Arche Sudbury
  131. Live & Learn Centre
  132. London Down Syndrome Association
  133. March of Dimes Canada
  134. Marsha Forest Centre
  135. Mary Centre of the Archdiocese of Toronto
  136. Member Family Support Network TCE
  137. Middlesex Community Living
  138. Millennial Womxn in Policy
  139. Montage Support Services
  140. MPN Ontario Patient Support Group
  141. Muscular Dystrophy Canada
  142. National Coalition of People who use Guide and Service Dogs
  143. National Educational Association of Disabled Students (NEADS)
  144. National Network for Mental Health (NNMH)
  145. Network of Women with Disabilities NOW
  146. New Vision Advocates
  147. No More Silence
  148. Older Women’s Network / Living in Place Campaign
  149. Ontario Association for Developmental Education
  150. Ontario Association of Independent Living Service Providers
  151. Ontario Association of the Deaf
  152. Ontario Autism Coalition
  153. Ontario Disability Coalition
  154. Ontario Federation for Cerebral Palsy
  155. Ontario Health Coalition
  156. Ontario Independent Facilitation Network
  157. Options Northwest Personal Support Services
  158. Ontario Parents of Visually Impaired Children – VIEWS for the Visually Impaired
  159. Ottawa Carleton Association for Persons with Developmental Disabilities
  160. Ottawa Independent Living Resource Centre
  161. P.A.D.D. Parents of Adults who have Developmental Disabilities
  162. PACE Independent Living
  163. Pacific Training Centre for the Blind
  164. Parkdale Community Legal Services
  165. Parkdale People’s Economy
  166. Participation Lodge Grey-Bruce
  167. Peterborough Community Legal Centre
  168. Peterborough Health Coalition
  169. PHSS-Medical & Complex Care in Community
  170. PooranLaw Professional Corporation
  171. Prisoners with HIV/AIDS Support Action Network
  172. Project 321 Peel Down Syndrome Association
  173. Project Autism
  174. PWA (Toronto People With AIDS Foundation)
  175. Realize
  176. RISE: Resource Centre for Independent Living
  177. Scleroderma Society of Ontario
  178. Shannon Law Office
  179. Students for Barrier-free Access
  180. Sudbury Community Legal Clinic
  181. Tangled Art + Disability
  182. The AIDS Committee of Durham Region
  183. The AIDS Network
  184. The Canadian Arthritis Patient Alliance
  185. The FASD E.L.M.O. Network
  186. The George Hull Centre for Children and Families
  187. The Legal Clinic (Perth, Sharbot Lake, Brockville)
  188. The Neighbourhood Group
  189. The Organization of Canadian Tamils With Disabilities (OCTD)
  190. The Participation House Project, Durham Region
  191. Toronto Family Network
  192. Toronto Yachad – The Canadian Jewish Council for Disabilities
  193. Total Communication Environment
  194. Traverse Independence
  195. Universities Allied for Essential Medicines (UAEM)
  196. Viability Employment Services
  197. Vibrant Health Care Alliance
  198. Vision Loss Rehabilitation Ontario
  199. Waterloo Regional Down Syndrome Society (WRDSS)
  200. Windsor-Essex Family Network
  201. Workers United Canada Council
  202. Working For Change
  203. York Region Lifetime Independent Facilitation
  204. 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.

Open Letter: Ontario’s Triage COVID-19 Protocol (08-04-2020)



Last Modified: May 14, 2020

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