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Opinion

Letters to the Editor: Rationing COVID-19 treatment to the elderly and disabled is illegal and immoral

Healthcare workers administer care for an intubated patient diagnosed with COVID-19 at the Chula Vista Medical Center intensive care unit April 20.
(Los Angeles Times)

To the editor: Thank you for your editorial opposing any triage system that takes disability, age or wealth into account. The Americans with Disabilities Act, which I authored, sought to ensure people with disabilities did not get the “short end of the stick” and were protected across all aspects of public life.

Throughout this COVID-19 crisis, disability advocates have stood up to states that introduced — or dusted off — crisis standards of care that violate civil rights through discriminatory “life year” and “survivability” calculations. Even if the emergency triage described remains theoretical, accepting state plans to discriminate will have lasting implications. It means we may choose not to accept the economic and social costs needed to protect the lives of people with disabilities and older adults next time, because we accept that their lives are less valuable.

We must hold state and federal leaders accountable for ensuring that the U.S. lives up to its promise of equal opportunity, nondiscrimination and protecting the civil rights of all human beings, especially in a crisis.

Tony Coelho, Doylestown, Pa.

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The writer was a Democratic member of Congress from California from 1979-89.

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To the editor: I appreciate the nuanced position your editorial takes. Under medical rationing proposals, both aging adults and disabled persons are sent to the back of the treatment line. Ethically, and under law, fair triage decisions cannot be based on age or disability, unrelated to who might benefit from treatment and survive hospitalization.

California’s draft rationing guidelines propose that “life cycles,” defined through set age ranges, be used as a tie-breaker. The ranges are arbitrary. They treat a 13-year-old the same as a person who is 40, and a 60-year-old differently than someone who is 61. The discrimination, based on age, is baked in.

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If two individuals are assessed likely to benefit from the same life-saving treatment, both should have the same chance of receiving it.

Susan Henderson, Berkeley

The writer is executive director of the Disability Rights Education and Defense Fund.

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To the editor: Your editorial seems to miss that the point of crisis triage is to save lives.

Triage is used daily in the healthcare setting. However, when the number of patients exceeds available resources, then difficult decisions must be made, and a different kind of triage — crisis triage — is employed. The goal is to provide the greatest good to the greatest number of people.

For example, in crisis triage, if two patients were to present severe COVID-19 infections requiring ventilation, one with chronic obstructive pulmonary disease (COPD) and the other with no comorbidities, then the ventilator would be allocated to the person most likely to survive. If the ventilator had been assigned to the person with COPD, both patients would die.

Of great concern is the fact that disability rights advocates, using laws that were not written to address a health crisis, successfully argued in Alabama that crisis triage is discriminatory. This threatens to upend the use of crisis triage and could increase the number of deaths as a result of COVID-19.

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Paul Clement, Upland

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To the editor: As a senior who is a contributing member of society both from a philanthropic and a volunteering perspective, I strongly object to a COVID-19 crisis triage protocol that takes a person’s remaining years into account when making ventilator decisions.

Let’s look at what the patient has contributed to society and will continue to contribute. Many seniors would “outrank” teenagers on such a measure.

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Besides, if I am 70 and going to live to 100, I still have 30 years left to enjoy, and I want every one of them.

Judith Wenker, San Diego

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To the editor: As physicians, we allow procedures to carry on when the expectations for patient survival are reasonable, independent of age, social status or any other consideration. That should apply to decisions on COVID-19 treatment too.

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As a person who has long passed his life expectancy (I am 84 years old), I find it unethical and odious to label me as disposable for any reason.

David S. Cantor, MD, Los Angeles


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