• Leah Hess

COVID-19 Triages Raise Questions about the Treatment of People with Disabilities in Medicine

Updated: Jul 20, 2021


With the onset of the COVID-19 pandemic in 2020, many hospitals found themselves at full capacity, forcing them to make decisions regarding resource allocation. Patient triage, the process of prioritizing patient care based on the severity of their condition or likelihood of recovery, is a common practice in hospitals. This unique situation, however, required healthcare workers to now largely base triage on an individual’s characteristics rather than those of their condition (as many COVID cases were similar in their care requirements). These decisions were often arbitrary and resulted in discrimination against people with disabilities, according to a study by the University of Georgia.


Most COVID-19 hospitalizations involve the utilization of ventilators, as severe cases manifest in difficulty breathing. Therefore, those in charge of triage had to assess which patients may be the best candidate for ventilator support. Emergency protocols issued by state governments served to standardize this triage procedure, but certain states listed individuals with brain injuries, cognitive disorders, or other intellectual disabilities as poor candidates for ventilator support. Other states implicitly made these claims by including vague guidelines instructing providers to provide resources to people who are more likely to survive. This puts people with underlying conditions, such as heart disease, diabetes, and cancer at a disadvantage. According to the CDC, adults with disabilities are three times more likely than adults without disabilities to have these underlying conditions. Similarly, many hospitals attempted to prevent the spread of the disease by limiting guests. Consequently, those with intellectual disabilities lost the aid of advocates and family members who may have been better able to communicate their needs to providers. Risk of death from COVID-19 was found to be 3.1 times greater for men with disabilities and 3.5 for women with disabilities. Similarly, the risk of death was 3.7 times greater for both men and women with learning disabilities. These stats beg the question: Are the conditions themselves leading to worse outcomes or is medical ableism to blame?


Ableism is defined as the discrimination of and social prejudice against people with disabilities based on the conscious or unconscious belief that typical abilities are superior. Ableism unfortunately pervades the medical industry; many people with disabilities, both physical and neurological, have faced medical biases even pre-pandemic, and fear that the recent pandemic will only worsen the way they are treated by medical professionals.


Lex Frieden, a quadriplegic (a person affected by paralysis of all four limbs) described his experiences to NPR, revealing the austere and ableist attitude of many individuals in health professions. Upon breaking his hip in a car accident and being rushed to the emergency room, he was told that it didn’t make sense to fix the hip of someone who would never walk anyway. This led to years of chronic pain.


This attitude is not an anomaly; a nationwide survey of doctors by Dr. Lisa Iezzoni of Harvard Medical School yielded disappointing responses. The vast majority (over 80%) of the doctors surveyed rated the quality of life of people with significant disabilities as worse than that of others. In times of emergency, where “quality of life” is used as a measurement, this can be a fatal opinion. Currently, only 1 state prohibits the denial of life sustaining treatment based on discriminatory factors.


There are laws currently in place to aid in the protection of people with disabilities in medical settings. These include the Americans with Disabilities Act of 1990 (or the ADA), the Rehabilitation Act of 1973, and the Affordable Care Act. The day-to-day enforcement of these laws, however, is largely left up to the discretion of individual providers, making stereotypes about life with a disability very dangerous.


To combat these biases, which are ingrained into the medical system, systematic changes are necessary. One option would involve integrating social workers into the emergency response process. These individuals are more qualified to make decisions for those who can’t speak on their own behalf. Targeting the root of the problem would also involve alteration of pre-medical and medical education. Training on how to work with people with disabilities is often not covered extensively- if at all. Even as the spread of coronavirus slows, the needs of the 15% of the global population with disabilities and the injustices they have faced should not be forgotten.

 

Speaking Plainly:

  • The emergency responses of hospitals to the COVID-19 pandemic has raised questions about how people with disabilities are treated in the healthcare industry.

  • Many able-bodied individuals believe that people with disabilities have a worse quality of life, leading to ableist practices in many areas of society.

  • During the pandemic, these biases resulted in people with disabilities ranking lower in triages and receiving fewer resources from hospitals.

  • Structural change, such as implementation of new policies, employment of patient advocates in hospitals, or increases in medical training, is necessary to combat biases and ensure equitable outcomes for all patients.