Manitobans with disabilities want policy on life-and-death decisions as COVID-19 patient numbers climb

As Manitoba hospitals fill with COVID-19 patients, people with disabilities are concerned there are no formal rules to determine who will or won’t receive medical care if there’s a shortage of staff or equipment.

Manitoba Shared Health says it doesn’t need this guidance, even though its own ethical framework for pandemic decision-making called for it a year ago.

The guidance is called a triage protocol — a policy that ensures people with disabilities and other vulnerable groups don’t face discrimination if hospitals run short of ventilators, beds or nurses.

The concern is if medical professionals choose to allocate resources to patients deemed most likely to recover, vulnerable patients would be more likely to die.

For more than a year, advocates for people with disabilities have been pushing the province to come up with a triage protocol.

“When you have limited resources and COVID numbers are going out of control, I don’t want life-and-death decisions made at the bedside,” said David Kron, who is executive director of the Cerebral Palsy Association of Manitoba and sits on the steering committee for the advocacy group Barrier-Free Manitoba.

“We want to make sure they don’t single us out [and to] make sure a disability doesn’t equal poor health.”

‘I really think that some proactive planning is important for the government,’ says David Kron, who is calling for a triage protocol. (John Einarson/CBC)

Since the start of the pandemic, several Canadian provinces have developed detailed triage protocols to prevent doctors and nurses from having to make life-and-death decisions on the fly.

In May 2020, Manitoba Shared Health developed an ethical framework for pandemic medical decisions that called for a triage protocol in this province.

“The decision-making processes in pandemic/disaster situations are different from those used in normal, day-to-day situations,” reads the framework, created by five Manitoba doctors and health administrators.

“Nevertheless, decisions must be justifiable and [the] rationale for each decision should be provided.

“Organizational decisions should not further disadvantage those already negatively impacted by structural disadvantage.”

The document states leadership and teams responsible for beds, ventilators, vaccine, IV fluid, personal protective equipment and nurses “should develop a triage process for determining how each resource will be allocated in times of scarcity.”

‘Hope is not a plan’

On Monday, Chief Nursing Officer and Shared Health systems integration lead Lanette Siragusa said the province does not need this protocol and will do everything it can to devote more staff to intensive care wards.

“We will look at all the options before we ever get to a triage protocol,” Siragusa said Monday during a news briefing.

“Hopefully we never have to make those decisions as health-care providers. Our goal is to help heal and maybe comfort, but not make those decisions.”

Kron called that position disturbing.

“Hope is not a plan,” he said. “We never thought we would be in this position a year ago and I really think that some proactive planning is important for the government. It’s for all at-risk groups, not just folks with disabilities.”

Siragusa said if the province requires a triage protocol, ethicists will be consulted. 

“If and when we need to have a triage protocol, we would certainly engage ethicists and we’d also engage our clinical providers, specifically those from critical care, but also others as necessary,” she said.

Opposition leaders have called on the province to create these protocols.

NDP Leader Wab Kinew has written twice to Dr. Brent Roussin, Manitoba’s chief provincial public health officer, warning Indigenous Manitobans could face worse outcomes without a triage policy.

“Given the fact some groups in our society face disproportionately more medical conditions that may … seem to suggest longer survival odds, we might then see these groups systematically disadvantaged in a system where life-saving medical attention is rationed,” Kinew wrote in a latter dated Nov. 18, 2020.

Liberal Leader Dougald Lamont also called for a triage protocol.

Asked Tuesday why the province didn’t have one, both Premier Brian Pallister and Health Minister Heather Stefanson pointed to the ethics framework that calls for the creation of a triage process.

As of Tuesday, Manitoba hospitals were treating 265 COVID-19 patients, including 70 getting intensive care. There are now 118 patients of all sorts — both COVID and non-COVID — in intensive care wards at three Winnipeg hospitals and one in Brandon.

The province is trying to alleviate pressure on hospitals by sending some stable non-COVID patients in acute-care facilities to other hospitals, sending some COVID patients home with oxygen, and sending others to long-term care homes.

Shared Health is also redeploying staff to COVID-19 care from other hospital areas, including surgical units. More staff are being trained, Siragusa said.