Massachusetts revises guidelines for crisis care amid unconscious bias concerns


After pushback from people with disabilities and minority communities, Massachusetts is changing its guidelines on deciding who gets ventilators and intensive care beds in the event of an unmanageable surge of COVID-19 patients, according to NPR radio station WBUR.

Care-rationing decisions must be made on the basis of short-term survival likelihood among patients, according to an amendment to the state's health department guidelines. The original guidelines were released April 7.

The revised guidelines state that a person's disability should not be the sole means of deciding how to distribute ventilators and ICU beds. Patient conditions that might affect the chances of long-term survival will no longer be part of the scoring system clinicians use to distribute lifesaving resources.

Though the original guidelines explicitly state that care-rationing decisions should not be made on the basis of several factors, including race, disability, gender and immigration status, there were concerns that this would not prevent discrimination from unconscious bias.

The new guidelines aim to "prevent unconscious bias against people of color, people with disabilities and other community members who are marginalized," a state health department spokesperson said, according to WBUR.

These guidelines are voluntary and were created by an advisory group "with extensive experience in medicine, ethics and public health," a health department spokesperson told WBUR in a statement.

"The guidelines have been revised to reflect the direct input of stakeholders to develop guidelines that clarify concerns regarding equity and disparities," the health department spokesperson said.

But there are still those who are concerned, despite the changes to the guidelines. Colin Killick, executive director of advocacy group Disability Policy Consortium, pointed out that focusing care-rationing on best short-term survival prognosis — which means those most likely to live for more than five years after COVID-19 recovery — does not take into account the fact that clinicians are often wrong when they predict life expectancy.

But Mr. Killick did express gratitude that the state was willing to make changes and said he appreciates the language around equity added, WBUR reports.




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