Triage, bias and Covid-19

I am currently watching “When They See Us” on Netflix (which I signed up for for a month and which will expire in a few days and I won’t renew it). It is based on real events and contains some vintage Trump. It is about bias and how it can ruin people’s lives.

This morning, I signed up for an online seminar to do with “Disability, Health, Law, and Bioethics”.

Triage and Covid-19. How can you be as fair as possible? By applying non-discrimination. By being as random as possible.

Just like it is not fair to rule against pregnant women because they require more care, it is not fair to rule against people with disabilities and other health challenges in addition to Covid-19.

Unless it is on purely medical grounds.

What do I mean by the latter? An extreme example is that there is no point in treating a dead person for Covid-19. The only rule would have to be whether a treatment would make sense, medically speaking. That’s likely easy enough to determine is still much easier to type than to do. (I have to define this.)

That a situation might be more complicated should not play a role.

If you were to apply such a biased rule with regard to disabled people, you would also have to apply that rule with regard to pregnant women. (Otherwise you are clearly discriminating against disabled people. That would even be illegal, wouldn’t it?)

But there is not enough staff and there are not enough mechanical ventilators.

So what do you do?

First come, first served. It is the only thing that makes sense.

Because it is more or less random.

You could argue that this would disadvantage the person whose spouse’s car broke down on the way to the hospital. Socioeconomic circumstances are a great discriminator, unfortunately.

Then I thought about it some more.

Well-to-do people generally go to – have access to – different hospitals and health-care providers.

And when I think about disabled people being at a disadvantage because they may for example take more time to get into a car, well, they also tend to have people around them who can assist, even now (I should damn well hope so!), while, say, the dad with two kids also has to manage the kids and get his seriously ill wife into the car.

So that probably more or less evened out.

If an ambulance is called, the process is the same regardless of who the patient is (or damn well should be).

There is the factor of distance to a hospital, but you could get stuck behind an accident in traffic a block from the hospital or have very light traffic from further away. That’s likely more or less random.

Plus, in most places, traffic is light right now.

Seems to me that “first come, first served” and then, while in hospital, those who require a ventilator first get one first.

Nobody should be taken off a vent purely to make way for someone else.

Also, because taking someone off a vent would have meant that the effort spent on the person who gets taken off the ventilator would likely go to waste.

That would not be an efficient use of resources.

(I know that having been on a vent for a while can help a person, but he or she should only be taken off the vent for medical reasons that only have to do with the person in question.)

The only fair way to triage people is severity of complaints, randomly. Skin color or disability or nationality or hair color and even age should have nothing to do with it.

I feel some protest in me when I think about the age factor. That comes from some bias in me.

Shouldn’t a 75-year-old make way for a 36-year-old if they have the same severity of complaints?

I notice that bias, with interest and surprise, and then I override it.

No. That would be discrimination.

And that would not be fair.

(If the older person in question makes that choice and states that he or she does not want the ventilator and states that it should go to someone else, that’s a different matter.)

Severity of complaints and “first come, first served” should be the only principles to base triage on.

I see no other way to keep triage fair.

Feel free to share your opinion below, please.

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