![]() ![]() The inequities of clinical triage frameworks We propose that the disability critique of clinical guidance documents for triage directs us towards a richer conceptualization of justice beyond the utilitarian maximization of welfare, and towards justice as positive freedoms. ![]() Informed by a disability rights lens, we seek to (1) critically examine clinical triage frameworks and elucidate how they may highlight existing inequities (2) propose ways in which these frameworks could be modified to fulfill obligations of justice and (3) translate these principles beyond the COVID-19 context into decision-making within the arenas of medicine and public health more broadly. Clinical triage protocols highlight the systemic deprioritization of individuals with disabilities at the point of triage. ![]() For instance, likelihood of survival is used to support withholding care from those with a greater than 80% predicted mortality, which aggregates mortality from severe illness with confounders such as baseline cognitive impairment, neurodegenerative disease, or functional capacity. These protocols highlight and potentially compound the disproportionate impact of acute health-system stressors on the lives of individuals who are already marginalized. Current approaches to design clinical decision-making protocols prompted by the COVID-19/SARS-CoV-2 pandemic have been criticized as being discriminatory towards individuals of advanced age, or those with complex needs or medical comorbidities. The decisions made during triage are of great consequence. The current global pandemic has been one such moment of resource strain requiring the development of these protocols. “Clinical Triage Protocols” are documents which serve to guide administrators and clinicians making decisions to partition and allocate care in such times of scarcity. Global emergencies require health care systems to shift into alternative operational states, modified to meet novel demands and overcome new constraints on resources. The clinical pandemic response, codified across triage protocols, should embrace a form of justice which incorporates a vision of pluralistic human capabilities and a valuing of positive freedoms. Informed by a disability rights critique of the clinical response to the pandemic, we offer direction for the construction of future clinical triage protocols which will avoid ableist biases by incorporating a broader apprehension of what it means to be human. We propose the capabilities theory, which recognizes that justice requires a range of positive capabilities/freedoms conducive to the achievement of meaningful life goals, as a means to do so. Here, we posit that engagement with the disability critique demands that we broaden our understandings of justice and fairness in clinical decision-making and patient triage. This utilitarian view necessarily marginalizes certain groups, in particular individuals with increased medical needs. While these documents differ in scope, they share a utilitarian focus on the maximization of benefit. The expectation of pandemic-induced severe resource shortages has prompted authorities to draft and update frameworks to guide clinical decision-making and patient triage. ![]()
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