Rights of Persons with Disabilities to Medical Treatment During the COVID-19 Pandemic
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Rights of Persons with Disabilities to Medical
Treatment During the COVID-19 Pandemic
Every patient is worth treating, but not every medical treatment
is worth providing. This determination must be based on an
evaluation of the potential success of the treatment, not a value
judgement about the person requiring aid.
We are faced with challenges of significant proportion that can impact, in a unique way,
persons with disabilities. However, persons with disabilities have the same rights as every
human being in the allocation of limited medical resources (e.g., access to ICU beds or
ventilators), in the face of a pandemic.
As The Office of Civil Rights of the U.S. Department of Health and Human Services has
recently reminded us, America’s basic civil rights laws, including the Americans with
Disabilities Act, prohibit discrimination based on race, color, national origin, disability, age, sex,
exercise of conscience and religion:
[P]ersons with disabilities should not be denied medical care on the basis of
stereotypes, assessments of quality of life, or judgments about a person’s
relative “worth” based on the presence or absence of disabilities.
Decisions. . .concerning whether an individual is a candidate for treatment
should be based on an individualized assessment of the patient based on the
best available objective medical evidence.
Office of Civil Rights, U.S. Dept. of Health and Human Services,
BULLETIN: Civil Rights, HIPAA, and the Coronavirus Disease 2019 (COVID-19) (March 28, 2020).
BULLETIN: Civil Rights, HIPAA, and the Coronavirus Disease 2019 (COVID-19) (March 28, 2020).
In other words, triage policies (policies for determining the priority of
non-arbitrary, non-discriminatory policies must recognize the innate dignity
of every human being, as consistently articulated by our Catholic tradition:
treatment to persons based on severity of their conditions) and Do Not
the patient based on the best available objective medical evidence.” Thus,
{T]his is the foundation of its concern to respect the sacredness of every
Resuscitate policies are to be based on “an individualized assessment of
human life from the moment of conception until death. The first right of
treatment to persons based on severity of their conditions) and Do Not
the human person, the right to life, entails a right to the means for the
19, he should not be denied a ventilator based on an ethic that others who can
current or anticipated “quality of life,” is required. For example, if an adult man
which medical treatment would be futile and cause more harm than benefit to
organ deficits, presents with compromised respiratory function due to COVID-
Concerning specific medical treatments, the principle of justice demands that
In other words, triage policies (policies for determining the priority of
... with patient (or designated decision-maker) consent, increasingly there are
Resuscitate (NR) policies are to be determined on “an individualized
documentable major organ function criteria, applied consistently and without
with Down Syndrome, who has significant cognitive impairment but no major
the person. However, such decisions must be made after review of objective
exceptions or exemptions. In other words, initial and repeatable assessment
While Do Not Resuscitate orders can be implemented ...
its allocation, including efforts at resuscitation, must be based on objective,
“BULLETIN: Civil Rights, HIPAA, and the Coronavirus Disease 2019 (COVID-19)” (March 28, 2020).
assessment of the patient based on the best available objective medical
Ethical and Religious Directives for Catholic Health Care Services, 6th Ed. (2018), Part One.
of each patient based on her ability to benefit from the treatment, not her
proper development of life, such as adequate health care.2
reports of the denial of resuscitation against consent. There are times in
evidence.” Thus, non-arbitrary, non-discriminatory policies must recognize the
No human being should be denied care.
innate dignity of every human being, as articulated by our Catholic tradition:
contribute more to society upon recovery are more deserving.
[T]his is the foundation of its concern to respect the sacredness of every
human life from the moment of conception until death. The first right of the
human person, the right to life, entails a right to the means for the proper
2 U.S. Conference of Catholic Bishops,
development of life, such as adequate health care.
U.S. Conference of Catholic Bishops,
Ethical and Religious Directives for Catholic Health Care Services, 6th Ed. (2018), Part One.
1 No human being should be denied care.
Concerning specific medical treatments, the principle of justice demands that
its allocation, including efforts at resuscitation, must be based on objective,
documentable major organ function criteria, applied consistently and without
exceptions or exemptions. In other words, initial and repeatable assessment
of each patient based on one’s ability to benefit from the treatment, not one’s
current or anticipated “quality of life,” is required. For example, if an adult man
with Down syndrome, who has significant cognitive impairment but no major
organ deficits, presents with compromised respiratory function due to COVID-
1
19, he should not be denied a ventilator based on an ethic that others who can
2
contribute more to society upon recovery are more deserving.
2 While Do Not Resuscitate orders can be implemented...
with patient (or designated decision-maker) consent, increasingly there are
reports of the denial of resuscitation against consent. There are times in
which medical treatment would be futile and cause more harm than benefit to
the person. However, such decisions must be made after review of objective
physiological criteria, evaluated by persons not directly involved in the case, or
in the caring for others competing for the same resources. For example, a 45-
year-old with quadriplegia and respiratory failure is not likely to survive COVID-
19 , despite the family’s desire that “everything be done.” However, families
need to be provided with transparent, publicly accessible policies, including
options for legal appeal, as well as given the option to transfer care to other
providers they identify.
In other words, triage policies (policies for determining the priority of
treatment to persons based on severity of their conditions) and Do Not
Resuscitate policies are to be based on “an individualized assessment of
the patient based on the best available objective medical evidence.” Thus,
non-arbitrary, non-discriminatory policies must recognize the innate dignity
3
of every human being, as consistently articulated by our Catholic tradition:
{T]his is the foundation of its concern to respect the sacredness of every
human life from the moment of conception until death. The first right of
the human person, the right to life, entails a right to the means for the
proper development of life, such as adequate health care.2
2 U.S. Conference of Catholic Bishops,
Ethical and Religious Directives for Catholic Health Care Services, 6th Ed. (2018), Part One.
their immediate medical issue.
as well as an assessment of what
1 No human being should be denied care.
available treatment could best address
treatment, not a value judgement about
This determination must be based on an
Concerning specific medical treatments, the principle of justice demands that
the person requiring aid. All people at all
evaluation of the potential success of the
times are worthy of care and compassion,
its allocation, including efforts at resuscitation, must be based on objective,
www.ncpd.org
documentable major organ function criteria, applied consistently and without
In times of limited resources...
exceptions or exemptions. In other words, initial and repeatable assessment
of each patient based on her ability to benefit from the treatment, not her
current or anticipated “quality of life,” is required. For example, if an adult man
National Catholic Partnership on Disability
with Down Syndrome, who has significant cognitive impairment but no major
organ deficits, presents with compromised respiratory function due to COVID-
Ethics and Public Policy Committee of the Board of the
19, he should not be denied a ventilator based on an ethic that others who can
Pope Francis, Day for Life Message, July 2013
contribute more to society upon recovery are more deserving.
measurable, objective clinical criteria that can indicate whether each
transparent resource allocation policies, to ensure they are based on
individual being evaluated can benefit from limited medical resources.
a human being. As a society the concept of solidarity with fellow human
beings dictates that any DNR or triage policy must treat each person as a
persons with disabilities. They have a right to have access to, and impact,
society must still strive to serve the good of each human being. However,
medical treatment is worth providing.
live forever, and deserving of the utmost reverence and respect.”
such allocation decisions never should be made based on the social worth of
unique irreplaceable human being. This applies to all human beings, including
2 While Do Not Resuscitate orders can be implemented ...
“Even the weakest and most vulnerable, the sick, the old, the unborn and the
Every patient is worth treating, but not every
poor, are masterpieces of God’s creation, made in his own image, destined to
... with patient (or designated decision-maker) consent, increasingly there are
reports of the denial of resuscitation against consent. There are times in
which medical treatment would be futile and cause more harm than benefit to
the person. However, such decisions must be made after review of objective
Derechos de las personas con discapacidades a
tratamiento médico durante la pandemia de COVID-19
Todo paciente es digno de ser tratado, pero no todo tratamiento
médico vale la pena de proporcionarse. Esta determinación debe
basarse en una evaluación de un éxito potencial del tratamiento, y
no en un juicio de valor sobre la persona que requiere la asistencia.
Nos enfrentamos a desafíos de una proporción significativa que pueden afectar, de manera única,
a las personas con discapacidades. Sin embargo, las personas con discapacidades tienen los
mismos derechos que todo ser humano en la asignación de recursos médicos limitados
(por ejemplo, acceso a las camas en la Unidad de Terapia Intensiva o ventiladores),
de cara a una pandemia.
Como nos ha recordado recientemente la Oficina de Derechos Civiles del Departamento de Salud y
Servicios Humanos (HHS) de EE. UU., las leyes básicas de derechos civiles de los Estados Unidos,
incluida la Ley de Estadounidenses con Discapacidades, prohíben la discriminación basada en
raza, color, origen nacional, discapacidad, edad, sexo, ejercicio de conciencia y religión:
A las personas con discapacidades no se les debería negar la atención médica con
base a estereotipos, evaluación de calidad de vida, o juicios sobre el "valor" de un
familiar de la persona basado en la presencia o ausencia de discapacidades.
Las decisiones...concernientes a si una persona es candidato para tratamiento
deberían basarse en un análisis individualizado del paciente basado en la mejor
evidencia médica objetiva.
Boletín Civil Rights, HIPAA, and the Coronavirus Disease 2019 (COVID-19), Oficina de Derechos Civiles,
Departamento de Salud y Servicios Humanos de EE.UU. (28 de marzo de 2020).Boletín Civil Rights, HIPAA, and the Coronavirus Disease 2019 (COVID-19), Oficina de Derechos Civiles,
Departamento de Salud y Servicios Humanos de EE.UU. (28 de marzo de 2020).
En otras palabras, las políticas de elección (que determinan la prioridad del
non-arbitrary, non-discriminatory policies must recognize the innate dignity
of every human being, as consistently articulated by our Catholic tradition:
the patient based on the best available objective medical evidence.” Thus,
{T]his is the foundation of its concern to respect the sacredness of every
tratamiento a las personas basada en la severidad de sus condiciones) y las políticas
Resuscitate policies are to be based on “an individualized assessment of
human life from the moment of conception until death. The first right of
treatment to persons based on severity of their conditions) and Do Not
the human person, the right to life, entails a right to the means for the
19, he should not be denied a ventilator based on an ethic that others who can
current or anticipated “quality of life,” is required. For example, if an adult man
which medical treatment would be futile and cause more harm than benefit to
organ deficits, presents with compromised respiratory function due to COVID-
Concerning specific medical treatments, the principle of justice demands that
In other words, triage policies (policies for determining the priority of
... with patient (or designated decision-maker) consent, increasingly there are
documentable major organ function criteria, applied consistently and without
de No Reanimación (NR) se deben determinar en "una evaluación individualizada del
with Down Syndrome, who has significant cognitive impairment but no major
the person. However, such decisions must be made after review of objective
exceptions or exemptions. In other words, initial and repeatable assessment
While Do Not Resuscitate orders can be implemented ...
its allocation, including efforts at resuscitation, must be based on objective,
“BULLETIN: Civil Rights, HIPAA, and the Coronavirus Disease 2019 (COVID-19)” (March 28, 2020).
paciente basado en la mejor evidencia médica objetiva". De esta manera, ni políticas
Ethical and Religious Directives for Catholic Health Care Services, 6th Ed. (2018), Part One.
of each patient based on her ability to benefit from the treatment, not her
proper development of life, such as adequate health care.2
reports of the denial of resuscitation against consent. There are times in
arbitrarias ni discriminatorias deben reconocer la dignidad innata de cada ser
No human being should be denied care.
humano, como lo expresa nuestra tradición católica:
contribute more to society upon recovery are more deserving.
Este es el fundamento de su preocupación respecto a la santidad de cada vida
humana desde el momento de la concepción hasta la muerte. El primer derecho de
la persona humana, el de la vida, implica un derecho a los medios para el desarrollo
apropiado de la vida, tal como la atención de salud adecuada. 2 U.S. Conference of Catholic Bishops,
Conferencia de Obispos Católicos de Estados Unidos,
Ethical and Religious Directives for Catholic Health Care Services, 6th Ed. (2018), Part One.
1 A ningún ser humano se le debería negar atención.
Respecto a tratamientos médicos específicos, el principio de justicia requiere de su
prestación, incluyendo los esfuerzos de resucitación, deben basarse en criterios
objetivos y documentados de la función de los órganos mayores, aplicados
consistentemente y sin excepciones ni excenciones. En otras palabras, la evaluación
inicial y repetible de cada paciente basada en la capacidad de la persona de
beneficiarse del tratamiento, sin requerirse la "calidad de vida" actual o anticipada. Por
ejemplo, si un hombre adulto con síndrome de Down, quien tiene una discapacidad
cognitiva significativa pero sin problemas en sus órganos mayores, presenta funciones
1
respiratorias afectadas debido al COVID-19, no se le debería negar un ventilador basado
2
en una ética de que otros pueden contribuir más a la sociedad tras recuperarse o que lo
merezcan más.
Mientras que las órdenes de No Reanimación
2
se pueden implementar...
con el consentimiento del paciente, o de una persona designada para tomar tal
decisión, cada vez hay más reportes de que no se respeta este consentimiento. Hay
veces en las cuales el tratamiento médico sería inútil y causa más daño que beneficio a
la persona. Sin embargo, tales decisiones deben hacerse después de la revisión de un
criterio psicológico objetivo, evaluado por personas no directamente involucradas en el
caso, o en el cuidado de otros que estén compitiendo por los mismos recursos. Por
ejemplo, un hombre de 45 años con cuadriplejía y fallo respiratorio no es probable que
sobreviva el COVID-19, pese al deseo de la familia de que "se haga todo." Sin embargo,
los familiares necesitan ser informados de políticas transparentes, públicamente
accesibles, incluyendo opciones de apelación legal, así como recibir la opción de
transferir el tratamiento a otros proveedores que determinen.“BULLETIN: Civil Rights, HIPAA, and the Coronavirus Disease 2019 (COVID-19)” (March 28, 2020).
InInother
otherwords,
words,triage
triagepolicies
policies(policies
(policiesfor
fordetermining
determiningthethepriority
priorityofof
treatment
treatmenttotopersons
personsbasedbasedononseverity
severityofoftheir
theirconditions)
conditions)and
andDoDoNotNot
Resuscitate
Resuscitatepolicies
policiesare
aretotobebebased
basedonon“an
“anindividualized
individualizedassessment
assessmentofof
thethepatient
patientbased
basedononthethebest
bestavailable
availableobjective
objectivemedical
medicalevidence.” Thus,
evidence.”Thus,
su
non-arbitrary,
non-arbitrary,non-discriminatory
non-discriminatorypolicies
policiesmust
mustrecognize
recognizethe
theinnate dignity
innatedignity
ylalos
3
Todas
clínicos
ofofevery
everyhuman
humanbeing,
being,asasconsistently
consistentlyarticulated
articulatedbybyour
ourCatholic tradition:
Catholictradition:
beneficiar
la sociedad
persona
evaluación
decisionesde
{T]his
{T]hisisisthe
thefoundation
foundationofofitsitsconcern
concerntotorespect
respectthe thesacredness
sacrednessofofevery every
tratamientos
destinados
pobres,
son respeto.”
medibles
nunca
human
humanlife lifefrom
fromthe
themoment
momentofofconception
conceptionuntil untildeath.
death.The Thefirst
firstright
rightofof
merecedoras
queson
the
aún debe
the
thehuman
humanperson,
person,the
theright
righttotolife,
life,entails
entailsa aright
righttotothe
themeans
meansfor forthe
Esta determinación
recursos
las personas,
situacióndemédica
-- Papa
un éxito
proper
properdevelopment
developmentofoflife, life,such
suchasasadequate
adequatehealth care.
healthcare. 2 2
requiere
se deben
tratamientos disponibles
disponibles
a vivir para
y objetivos
2 U.S.
2 U.S. Conference
Conference of of Catholic
Catholic Bishops,
Bishops,
su situación médica Alianza
Ethical and Religious Directives Catholic Health Care Services, (2018), Part One.
médicos
Ethical and Religious Directives forfor
Catholic Health Care Services, 6th6th
Ed.Ed.
(2018), Part One.
de cuidado
en todos
Comité
tratar deque
tomar
inmediata.
inmediata.
pudiera
servir
debe basarse
Francisco,
obraslamaestras
siempre,
potencial del
evaluación de un éxito potencial del
1 1 No
Nohuman
humanbeing
beingshould
shouldbebedenied care.
deniedcare.
asistencia.
la persona que requiere la asistencia.
puedan
“Incluso los más débiles y vulnerables,
beneficiar de recursos médicos limitados.
limitados.
de Política
Concerning
Concerning specific
specific medical
medical treatments,
treatments, thethe principle
principle ofof justice
justice demands
demands that
that
en una
Esta determinación debe basarse en una
atender
pudiera atender
los tiempos,
Todas las personas, en todos los tiempos,
así como de una evaluación de cuál de los
así como de una evaluación de cuál de los
y compasión,
son merecedoras de cuidado y compasión,
tratamiento, y no en un juicio de valor sobre
tratamiento, y no en un juicio de valor sobre
itsits allocation,
allocation, including
including efforts
efforts atat resuscitation,
resuscitation, must
must bebe based
based onon objective,
objective,
por elindicar
bien de
www.ncpd.org
www.ncpd.org
documentable
documentable major
major organ
organ function
function criteria,
criteria, applied
applied consistently
consistently andand without
without
exceptions
exceptions oror exemptions.
exemptions. InIn other
other words,
words, initial
initial andand repeatable
repeatable assessment
assessment
si cada
ofof each
each patient
patient based
based onon her
her ability
ability toto benefit
benefit from
from the
the treatment,
treatment, notnot her
her
En tiempos de recursos limitados...
cada ser
transferir el tratamiento a otros proveedores que determinen.
current
current oror anticipated
anticipated “quality
“quality ofof life,”
life,” is is required.
required. ForFor example,
example, if if
anan adult
adult man
man
Comité de Política Pública y Ética de la
Pública y Ética de la
with
with Down
Down Syndrome,
Syndrome, who
who has
has significant
significant cognitive
cognitive impairment
impairment butbutnono major
major
individuo
organ deficits, presents with compromised respiratory function due COVID-
Alianza Nacional Católica sobre la Discapacidad
Nacional Católica sobre la Discapacidad
organ deficits, presents with compromised respiratory function due toto
COVID-
humano.
19,19,
hehe should
should notnot
bebe denied
denied a ventilator
a ventilator based
based ononanan ethic
ethic that
that others
others who
who can
can
contribute
contribute more
more toto society
society upon
upon recovery
recovery areare more
more deserving.
deserving.
evaluado
discapacidades. Ellos tienen el derecho a tener acceso e impacto a políticas
discapacidades. Ellos tienen el derecho a tener acceso e impacto a políticas
accesibles, incluyendo opciones de apelación legal, así como recibir la opción de
transparentes de asignación de recursos, para asegurar que se basen en criterios
transparentes de asignación de recursos, para asegurar que se basen en criterios
Sin embargo,
basadas en el valor social de una persona. Como
respeto.” -- Papa Francisco, mensaje del Día de la Vida, julio de 2013.
mensaje del Día de la Vida, julio de 2013.
No Reanimación, o triaje y deben tratar a cada persona como un ser humano único e
No Reanimación, o triaje y deben tratar a cada persona como un ser humano único e
sociedad, el concepto de solidaridad con nuestros prójimos dicta que las políticas de
sociedad, el concepto de solidaridad con nuestros prójimos dicta que las políticas de
tratamiento médico vale la pena de proporcionarse.
clínicos medibles y objetivos que puedan indicar si cada individuo evaluado se puede
tratamiento médico vale la pena de proporcionarse.
se puede
Todo paciente es digno de ser tratado, pero no todo
Todo paciente es digno de ser tratado, pero no todo
destinados a vivir para siempre, y merecedores de la máxima reverencia y
y merecedores de la máxima reverencia y
WhileDoDoNot
NotResuscitate
Resuscitateorders
orderscan
canbebeimplemented
implemented......
irreemplazable. Esto se aplica a todos los seres humanos, incluyendo las personas con
irreemplazable. Esto se aplica a todos los seres humanos, incluyendo las personas con
22 While
y los pobres, son obras maestras de la creación de Dios, hechos a su imagen,
de la creación de Dios, hechos a su imagen,
tales
los enfermos, los ancianos, los no nacidos
“Incluso los más débiles y vulnerables, los enfermos, los ancianos, los no nacidos
NCPD...donde la fe y la discapacidad se encuentran.
...... with
with patient
patient (or(or designated
designated decision-maker)
decision-maker) consent,
consent, increasingly
increasingly there
there are
are
reports
reports ofof the
the denial
denial ofof resuscitation
resuscitation against
against consent.
consent. There
There are
are times
times inin
which
which medical
medical treatment
treatment would
would bebe futile
futile and
and cause
cause more
more harm
harm than
than benefit
benefit toto
thethe person.
person. However,
However, such
such decisions
decisions must
must bebe made
made after
after review
review ofof objective
objectiveYou can also read
