TORONTO, April 3, 2020 (LifeSiteNews) — A doctor who has euthanized people and lobbied to legalize lethal injection for sick patients in Canada is behind Ontario’s proposed triage protocol to decide who will get care if the medical system is overwhelmed by coronavirus patients.
Dr. James Downar, former chair of the physicians advisory committee for Dying with Dignity, led the drafting of the Ontario Health protocol, which is not public but was leaked to the media this week, with the Globe and the Toronto Star reporting on it.
The draft document proposes a triage protocol that will be triggered when the medical system is at a “breaking point,” which it defines as working at 200 percent of normal capacity, reported the Star.
The protocol has three levels of criteria that become more restrictive as strain on the system increases.
The first level “would deny life-saving treatment to those with more than an 80-per-cent chance of death from trauma, and those who are unable to perform daily tasks because of a severe cognitive impairment from a progressive illness,” the Globe reported.
“The wording suggests that some individuals with dementia would be denied life-saving care, but that individuals with developmental delays not caused by progressive illness would still qualify for such care,” it added.
The second level “denies life-saving treatment to those with more than a 50-per-cent chance of death. The third level applies to those with more than a 30-per-cent chance of death.”
The protocol has three principles: “utility (those who derive maximum benefit receive the care); proportionality (the number harmed by the protocol should not exceed the number harmed under a first-come, first-served approach) and fairness (‘priority should not be given to anyone on the basis of socio-economic privilege or political rank’),” according to the Globe.
The triage system will assess patients using “inclusion and exclusion criteria,” the Star reported, with patients “who are very likely to die from their critical illness, and people who are very likely to die in the near future even if they recovered from their critical illness” excluded.
Patients who “no longer meet the criteria for care” will be taken off ventilators or not offered them. However, they will receive “the highest priority for palliative care,” the Star reported, adding that the triage protocol is “coupled with a clear palliative care plan.”
It appears that Downar, head of the division of palliative care at the University of Ottawa and a palliative care physician at Ottawa Hospital and Bruyère Continuing Care, also had a hand in this palliative care plan.
He and three others published a draft document in the Canadian Medical Association Journal (CMAJ) on Tuesday on “Pandemic palliative care,” which said “palliative sedation” could be used to bypass the law for patients dying of the coronavirus who allegedly expressed a desire for euthanasia.
“In our opinion, palliative sedation is preferable to medical assistance in dying (MAiD) for patients with severe respiratory failure caused by SARS-CoV-2, given the 10-day reflection period, number of witnesses and assessors required, and the current requirement for full capacity to determine eligibility for MAiD,” wrote Downar, et al.
“Attempting to honour an urgent MAiD request is likely to prolong suffering in those who are imminently dying.”
Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, said the proposed triage protocol is illegal because Ontario courts have been clear that consent is required both to provide and to withdraw treatment.
“Therefore, to remove a patient from life-saving intervention, even with good intention, cannot be done without consent,” he told LifeSiteNews.
While Catholic medical ethics considers a respirator as “extraordinary means, so it’s not obligatory, with COVID-19, we’re not talking about a permanent respirator; we’re talking about temporary use of a respirator — that’s a very important distinction,” he said.
“Denying this to someone would actually be denying them use of effective treatment that would result in them getting better.”
While “it is ethical to recognize that somebody is not getting better and there’s nothing we can do,” denying people life-saving care on a utilitarian basis and because their lives are viewed as less valuable, such as on the basis of age, dementia, or disability, is discriminatory and “immoral,” he said.
That was echoed by Joseph Meaney, president of the Philadelphia-based National Catholic Bioethics Center (NCBC), who told Crux that medical centers may need a “just form of triage” to cope with the crisis.
“There is a medical-moral duty to deliver care, so no one should be refused medical help. The agonizing problem that is currently confronting Italy, and potentially other countries soon, is that certain very intensive therapies cannot be given to more than a certain number of patients at a time. There are only so many ventilators available, for instance,” Meaney said.
“Succinctly speaking, objective criteria must be used to give the most limited intensive therapies to those most in need who can still benefit from them,” he added.
However, “it would not be ethical to triage a person out simply on the basis of their age, disability, sex, etc. It is true that some elderly patients may not meet objective criteria for ventilator access in a crisis situation because they are dying and it is impossible to save them, but that can also be true of younger patients. We have to be very mindful of not discriminating. The slippery slope goes downhill very rapidly once one starts on that road.”