The 17 Recommendations
Recommendation 1: The development of a triage protocol is essential to help safeguard against persons with disability and older persons being subject to the very real risk of arbitrary and discriminatory decision-making.
Recommendation 2: The development of a triage protocol should be guided by the constitutional and human rights of all patients, including persons with disabilities and older persons.
Recommendation 3: In order to guarantee the equal rights of persons with disabilities and older persons to fully participate on an equal basis with others and to access healthcare and lifesaving procedures during the pandemic, the discussion and development of response efforts including triage, priority setting and resource rationing and allocation must include substantive and meaningful consultation and engagement with persons with disabilities, older persons, their families and caregivers as well as representative communities.
Recommendation 4: The process leading to the development of a triage protocol must be transparent. All stages of the discussion should be made public and accessible with due notice to ensure inclusion and substantive, meaningful consultation.
Recommendation 5: The results of the discussions at relevant stages of protocol development should provide opportunity for stakeholder input to be incorporated.
Recommendation 6: The draft triage protocol should be assessed and screened to ensure its lawfulness, constitutionality, and compliance with human rights obligations.
Recommendation 7: A protocol should articulate and distinguish between substantive elements (i.e. the criteria used to make resource allocation decisions) and procedural elements (i.e. the processes within which the substantive criteria are applied and may include safeguards).
Recommendation 8: Both substantive and procedural elements should be anti-ableist and anti-ageist.
Recommendation 9: While certain disabling or age-related conditions can involve health issues that are relevant to recovery from Covid-19, in order to not create, perpetuate or exacerbate institutionalized ableism, ageism, structural discrimination or discriminatory impacts, it is imperative to clearly distinguish disabling condition(s) from Covid-19 survivability. In other words, patients with similar health conditions must receive equal treatment and care. A person’s disability, age or attendant aspects of a disability or older age (care, accommodation, public funding, etc.) should never be a factor in determining whether an individual should or should not receive a lifesaving medical treatment.
Accordingly, a protocol should include:
- affirmation of the inherent dignity, right to life and equality of all persons;
- affirmation that all measures will be taken to enable persons with disabilities and older persons to fully participate on an equal basis with others;
- express commitment to ensuring care, support as well as accommodations for persons with disabilities and older persons regardless of whether their disability or condition is stable or progressive; and
- ethical principles that “prioritize treatment for persons in situations of particular vulnerability, including persons with disabilities” and older persons.
A protocol should exclude:
- resource rationing or allocation decisions based on assessment of disabling conditions, age or conditions associated with aging;
- resource rationing or allocation decisions based on assumptions about quality or value of life based on disabling conditions, age or conditions associated with aging;
- the use of clinical tools or metrics whereby resource rationing or allocation decisions are based on assessment of disabling conditions, age or conditions associated with aging which are or can be addressed by treatment, care, support and accommodations; and
- resource rationing or allocation decisions based on the costs (real or perceived) associated with treatment, care, support and accommodations for persons with disabilities or older persons.
Recommendation 10: Patients and their family, friends or caregivers, in accordance with the patient’s wishes, should be involved in decision-making. This should include the communication of information regarding critical care, options, the triage process, as well as how to appeal an allocation decision.
Recommendation 11: Accommodation and support to enable full participation by persons with disabilities and older persons must also be provided. Accommodation and support should be human rights-based and should therefore include supported decision-making realized to the fullest extent possible and where competency may be at issue, substitute decision-making should be utilized (e.g., SDM, proxy, trustee) in accordance with the law and the individual’s known wishes and values.
Recommendation 12: A provincial assessment team should be established consisting of health care professionals and at least one member of the public with lived experience, all of whom must have expertise or training in disability rights, ageism and human rights.
Recommendation 13: Triage policy, protocols and guidelines should be made public and accessible to ensure transparency between the government and the public.
Recommendation 14: All resource rationing or allocation decisions should be documented and where permissible, data, in the appropriate form, should be reported to the public particularly with respect to decisions where critical care was denied.
Recommendation 15: Triage policy, protocols and guidelines should be reviewed, assessed and revised to ensure adherence to human rights obligations, to protect individual human rights and to guard against structural and systemic discrimination.
Recommendation 16: All health care personnel must be made alert to human rights and the realities of disability discrimination, ageism and bias.
Recommendation 17: Health care professionals, particularly those involved in resource rationing or allocation policy, assessment and decision-making must be educated on the triage protocol and the human rights implications of triage protocols.
 United Nations, Policy Brief: A Disability-Inclusive Response to Covid-19 (May 2020), page 11.
*For the Human Rights at issue, Guiding Principles and Recommendations, download the full statement here (pdf).