Disability ethics in the coronavirus crisis

Abstract

The disability viewpoint is fundamental for understanding and advancing social justice for everyone in the population. Despite this fact, it is regularly dismissed by public health experts and policymakers. Understanding of disability rights is central in an all-inclusive COVID-19 preparedness. This paper attempts to explore disability ethics in understanding structural discrimination, equitable practices, respect for disability culture and ways to safeguard health care professionals with disabilities in the coronavirus pandemic. In crisis standards of care, resource allocations must not be solely based on a disabled person's subjective quality of life. Health professionals should avoid stereotypes about an individual's disability to ration care. Triage protocol committees and disaster risk reduction working groups should explicitly recruit people with disabilities and chronic illnesses in their response strategies. Disability ethics can reform medical rationing by removing prejudices and safeguarding fair protection of the interests of all patients, including those with a disability.

Health Risks and Consequences of a COVID-19 Infection for People with Disabilities: Scoping Review and Descriptive Thematic Analysis

“…People with visual or hearing impairments also may face infection risk because of a lack of accessible information on preventive measures during the initial stages of the pandemic. [ 16 , 48 , 49 , 50 ] In Low- and Middle-Income Countries (LMICs), the situation can be worse [ 49 ]. For instance, an audit of press conferences in LMICs showed that only 65% of countries have used a sign language interpreter, with figures varying from 33% to 88% [ 74 ].…”

“…Other published accounts point out that, in the USA, some states were endorsing guidelines to withhold ventilators and treatment from those with certain neurological impairments and intellectual disabilities [ 53 , 56 , 59 , 62 ]. In some jurisdictions, policies have been issued for people with disabilities to have a lower priority to receive critical and lifesaving medical care; at a very minimum, confusion around this (or lack of clear statements otherwise) could further limit access to lifesaving care for people with disabilities [ 6 , 28 , 44 , 46 , 48 , 53 , 56 ]. For example, guidelines stating that survival of younger healthy persons is to be prioritized relative to “chronically debilitated patients” can be interpreted to disadvantage people with disabilities, even if young or otherwise healthy [ 53 ].…”

“…Aligned with this, for example, the Office for Civil Rights in the US has issued guidance to States and healthcare providers, early during the pandemic, stating that disability rights and anti-discrimination laws are not waived during the pandemic [ 83 ]. Furthermore, in person or remotely involving diverse people (e.g., disability activist or scholars, ethicists, healthcare providers with disabilities, rehabilitation professionals, and others more likely aware of disability rights), in reviewing or taking collective life-saving medical decisions, may reduce the likelihood of personal biases in medical rationing decisions [ 48 , 49 ]. For the development of equitable guidelines, people with disabilities or their advocates might be actively involved.…”

“…On the one hand, this may be due to the little time to conduct and publish studies up to mid-September 2020; in the paragraph above, we provided an example of one additional study published afterward. On the other hand, it may also reflect the fact that disability status is not systemically included in health surveillance systems or electronic medical or administrative records [ 34 , 48 , 54 , 90 ]. This lack of readily available data, and especially so in LMICs, may have undermined the ability to produce rapid studies on any disproportionate effects of the COVID-19 infection on people with disabilities.…”

Subsequent Curves of COVID-19 in Society

“…The task relevance of the bioethics and research ethics committees of hospitals as having a substantial role in decision-making was deliberated and reactivated. The position of preserving fundamental rights in a crisis scenario entails critical routes with greater balance, apart from biased and discretional decisions ( 7 ). Certainly, many collaterals have emerged from these curves, and in the case of the guidelines, the challenge is to link them to decision making with a legal basis, beyond the traditional figure of recommendations.…”