Long Term Care Home Analysis – Part 10 – CMA Document
Continuing from Part 9 | Part 8 | Part 7 | Part 6 | Part 5 | Part 4 | Part 3 | Part 2 | Part 1 and with the analysis of this article:
Continuing with documents in this article by Rosemary Frei,
Then on April 10, the Canadian Medical Association adopted all the recommendations by Dr. Ezekiel and his co-authors in their New England Journal of Medicine paper, and advised Canadian physicians to follow them.
The CMA claimed that there was no time for Canadians to create their own recommendations even though:
. . . many had direct clinical experience with a close cousin of the novel coronavirus, SARS-CoV, in 2003.
. . . four Canadians co-authored an ethical framework for guiding decision-making during a pandemic that was based on their experience with SARS and published in 2006. They made no mention of age as a criterion for treatment triaging in that framework.
Looking at the CMA document: CMA Policy: Framework for Ethical Decision Making During the Coronavirus Pandemic | “Approved by the CMA Board of Directors April 2020”
But in contexts of resource scarcity, when there are insufficient resources, difficult decisions have to be made about who receives critical care (e.g., ICU beds, ventilators) by triaging patients. . . . Priority-setting for resource allocation becomes more ethically complex during catastrophic times or in public health emergencies, such as today’s COVID-19 pandemic, when there is a need to manage a potential surge of patients.
So, this CMA document basically mention the same two justifications or conditions that the Ontario government was required to use by the law they applied to declare a state of emergency and special powers:
1) EMERGENCY: The claim is that there is an emergency. This document implies COVID-19 is a “pandemic” and “catastrophic” and an emergency.
2) INSUFFICIENT RESOURCES: This document claims that there is or was “insufficient resources” and “resource scarcity” with respect to the COVID-19 event.
Those are the two conditions the Ontario government supposedly met in order to make their declaration.
So in addition to going against rights and freedoms, governments overturned fundamental moral and ethical rules regarding health care.
In my view, those two conditions aren’t even true. There wasn’t any lack of resources (but that would be a result of their policies more and more).
That was their prediction and assumption based on incidents portrayed by the media in New York, Italy and China. I have posted information that challenges the stories about what happened at these locations. (New York: this post and a post about the nurse’s accounts, Italy: air pollution study, China: pneumonia/air pollution articles).
Even so, the numbers for Ontario now in August do not justify an emergency. There were things going wrong though for sure as a result of their policies. That’s what this discussion is about.
What kind of hypocrisy is required for governments to preside over predictable disasters in long-term care homes (because of their neglect, because of the fear and because of the isolation and other policies) AFTER JUST ISSUING A POLICY ADVISING HEALTH CARE RATIONING that is obviously intended to minimize treatment for the elderly and frail? It’s amazing. They are the most vulnerable every flu season so they need the most protection and they didn’t get that! Who was visiting them?! Who was making sure they weren’t neglected? All the restrictions were in place limiting visits by families.
Physicians from China to Italy to Spain to the United States have found themselves in the unfathomable position of having to triage their most seriously ill patients and decide which ones should have access to ventilators and which should not
So they refer to these hot-spots (we’re supposed to assume the official media story is the truth about each case) to make their argument. It’s emotionally laden, it’s not appropriately objective at all!
“unfathomable”!? And the document goes on like that with the posturing, hand-ringing, and manipulation.
And this point about “access to ventilators”–is that even an appropriate treatment for a frail and elderly person anyway? Aren’t there other real treatments? Yes. This is a point about the mainstream coverage that has been challenged–but these challenges have been suppressed. This is a false choice.
(Posts relating to this question about ventilators: here, here, this article explains it, and also).
. . . While the Canadian Medical Association hopes that Canadian physicians will not be faced with these agonizing choices, it is our intent . . . to provide them with guidance in case they do and enable them to make ethically justifiable informed decisions in the face of difficult ethical dilemmas.
I’m highlighting the emotional filler words. Is that a scientific use of language?
It says it should only be a “last resort” but I think this policy was intended to be introduced for the first time and applied during COVID-19 and it was.
. . . physicians should carefully document their clinical and ethical decisions . . .
Generally, the CMA would spend many months in deliberations and consultations with numerous stakeholders, including patients and the public, before producing a document such as this one. The current situation, unfortunately, did not allow for such a process. . .
So they turned to Italian “colleagues and ethicists” as well as Canadian doctors and provincial level frameworks.
But there already was a Canadian document on this subject as mentioned above. Whether they knew about it or not, I don’t think they liked it.
The CMA is endorsing and recommending that Canadian physicians use the guidance provided by Emmanuel and colleagues in the New England Journal of Medicine article dated from March 23rd, as outlined below.
So this is the famous Emmanuel (discussed in an earlier post) of the U.S. “death panels” controversy which we now understand so much better in retrospect–because of course that is what “health care rationing” is about after all. If somebody postures as if it is very “progressive” and correct while opponents are “narrow-minded,” that’s how these powerful corporate forces sell us on LOSING our sense of value for human life. People should read Brave New World and they should watch the video with George Bernard Shaw.
Here is the dramatic point about “ventilators” repeated, as well as the implication that there are going to be shortages:
The CMA will continue to advocate for access to personal protective equipment, ventilators and ICU equipment and resources.
CTV News reported that Canadian hospitals were way below capacity and under-used, that surgeries were cancelled, etc.
It should be noted that some provinces and indeed individual health care facilities will have their own protocols or frameworks in place. At the time of its publication, this document was broadly consistent with those protocols that we were given an opportunity to review.
So note that there were already provincial documents introduced (as mentioned by the Star article of March 29 for Ontario) that the CMA compared its document to. That is evidence of a very high level of coordination.
The CMA recognizes that physicians may experience moral distress when making these decisions. We encourage physicians to seek peer support and practice self-care. In addition, the CMA recommends that triage teams or committees be convened where feasible in order to help separate clinical decision making from resource allocation, thereby lessening the moral burden being placed on the individual physician.
So it sounds like the doctor probably isn’t even making these decisions on his or her own. It is a “committee” of administrators–the people “in charge” of this show.
I had a series of posts discussing freedom of conscience in the medical profession being under attack in recent years, in Canada and internationally. That is another thing we can understand better no in retrospect.
The CMA recommends that physicians receive legal protection to ensure that they can continue providing needed care to patients with confidence and support and without fear of civil or criminal liability or professional discipline . .
I think this is what decades of the corporate training on “teams” and on being good corporate employees has been all about in the “managerial society.” This is what the excessive emphasis on “team work” in corporate environments has been about. Team work has its place if it is based in an appropriate value system, but if left unanchored, it becomes about allowing the Brave New World degradation and commodification of human biology to go ahead–including euthanasia and life-boat policies, because the concept of a team makes it easier to override personal conscience.
So this huge change in policy was made with all the potential morally questionable decisions, and it was made in other countries also like the UK (as referred to earlier), all “because of COVID-19.”
There are 6 recommendations:
Recommendation 1 refers to:
the value of maximizing benefits
Priority for limited resources should aim both at saving the most lives and at maximizing improvements in individuals’ post-treatment length of life. Saving more lives and more years of life is a consensus value across expert reports.
The part of the equation that mentions “length of life” and “more years of life” seems to me to put more value on younger people who are expected to live longer.
They actually throw in both points of view and try to say they agree on this point:
It is consistent both with utilitarian ethical perspectives that emphasize population outcomes and with nonutilitarian views that emphasize the paramount value of each human life.
The way that both systems are put together in the same sentence and equated somehow is clever marketing. The more they can do that, the more they can sell death panels and health care rationing.
There are many reasonable ways of balancing saving more lives against saving more years of life; whatever balance between lives and life years is chosen must be applied consistently
“Many”? I have a suggestion. Let’s have an economy and stop advocating scarcity and austerity. And let’s have MORE life-saving for more human beings–because there is plenty of room. Overpopulation is a lie told for generations by the elites. But let’s give people proper treatment at any age and help them live their lives more happily even if it’s just a few years. More prosperity for everyone. But if you are busy trying to reduce resource use and shutting down economies due to viruses (viruses are always there), then you’re not really interested in that way of doing things, are you? This is the Great Reset..
People have been confused by the propaganda over the years. We’ve had many years of it. But I think it’s time that people make some choices about WHAT they even believe and WHAT they value. Do they see other humans as a pollution-spewing plague like governments and the media have portrayed them as? That’s how they want you to see them!
So here is a key statement:
Limited time and information in a Covid-19 pandemic make it justifiable to give priority to maximizing the number of patients that survive treatment with a reasonable life expectancy and to regard maximizing improvements in length of life as a subordinate aim.
Notice that they claim there was limited information about COVID-19. Only because of censorship and propaganda. Even Fauci wrote an article in the New England Journal of Medicine saying that the fatality rate was likely to be low–based on Chinese data–and that’s how it turned out.
So the very elderly would not fare well with that rule.
But most of the patients who were the most ill, and who died, we know now from the official statistics page–as of August–that about 71.5% of them were over 80.
So these COVID-19 health care rationing policies directly relate to what kind of care an elderly person over a certain age gets (possibly these policies are not in every jurisdiction) as long as governments continue to impose the alarm about COVID-19.
I think that’s part of the reason for COVID-19. It’s a major change in how we are supposed to see resources, the elderly and each other. The more the economy is shut down, the less resources for everyone–so the more rationing of all kinds is likely. And that includes how many people are born as well as who lives and who dies.
This is the Great Reset of the World Economic Forum. This is their implementation of “sustainable development.” We have been taught that is a good thing but we’ve been misled.
Don’t get defensive. Just wise up. Let’s not continue with the left-right paradigm. Parties of all stripes in Canada and elsewhere have supported policies related to “sustainable development” since before Agenda 21 was agreed in 1992. They just don’t announce it. Even the Conservative Party passed the federal “Sustainable Development Act” in the mid-2000s but there were many years of developments prior to that.
. . . encouraging all patients, especially those facing the prospect of intensive care, to document in an advance care directive what future quality of life they would regard as acceptable and when they would refuse ventilators or other life sustaining interventions can be appropriate.
But is referring to “ventilators” appropriate? Is that skewing the picture about what intensive care and “life sustaining interventions” are available?
Another clearer statement (it’s never going to be so clear as it should be):
Operationalizing the value of maximizing benefits means that people who are sick but could recover if treated are given priority over those who are unlikely to recover even if treated and those who are likely to recover without treatment. Because young, severely ill patients will often comprise many of those who are sick but could recover with treatment, this operationalization also has the effect of giving priority to those who are worst off in the sense of being at risk of dying young and not having a full life
So it decides against the older patients.
Because maximizing benefits is paramount in a pandemic [what are the facts about the number of deaths and how few have serious symtpoms?], we believe that removing a patient from a ventilator or an ICU bed to provide it to others in need is also justifiable and that patients should be made aware of this possibility at admission [are there reports of this?]. Undoubtedly, withdrawing ventilators or ICU support from patients who arrived earlier to save those with better prognosis will be extremely psychologically traumatic for clinicians — and some clinicians might refuse to do so. However, many guidelines agree that the decision to withdraw a scarce resource to save others is not an act of killing and does not require the patient’s consent. We agree with these guidelines that it is the ethical thing to do. Initially allocating beds and ventilators according to the value of maximizing benefits could help reduce the need for withdrawal.
They are just wrong. Notice that they expected doctors to be repulsed by this practice. It is wrong to withdraw treatment. I don’t think it is about ventilators. It is about life-saving treatments of all kinds. It could be as basic as food and water. The notion of ventilators is like some kind of endless, repeated non sequitur. They need proper treatments for all ages.
Also it is ridiculous to claim there is a scarce resource of this medical equipment. This has been worked up in the media portrayal of events. They’re introducing us to a new system and way of life.
I’m going to highlight this part of the quote:
Initially allocating beds and ventilators according to the value of maximizing benefits could help reduce the need for withdrawal.
This implies that the ICU beds would be rationed under this policy and probably means that even hospital beds would be rationed–as with the Toronto Star report–that elderly long term care patients would be kept out of hospitals.
. . . Critical Covid-19 interventions —testing, PPE, ICU beds, ventilators, therapeutics, and vaccines —should go first to front-line healthcare workers and others who care for ill patients and who keep critical infrastructure operating, particularly workers who face a high risk of infection and whose training makes them difficult to replace. These workers should be given priority not because they are somehow more worthy, but because of their instrumental value: they are essential to pandemic response. If physicians and nurses and RTs are incapacitated, all patients —not just those with Covid-19 —will suffer greater mortality and years of life lost. Whether health workers who need ventilators will be able to return to work is uncertain but giving them priority for ventilators recognizes their assumption of the high-risk work of saving others. Priority for critical workers must not be abused by prioritizing wealthy or famous persons or the politically powerful above first responders and medical staff —as has already happened for testing. Such abuses will undermine trust in the allocation framework
Notice that they are applying this recommendation to COVID-19 so it’s reasonable to think the whole set of policies took effect.
Notice that they consider testing and vaccines to be “critical” COVID-19 interventions even though there were no “vaccines” or any reason to think they will be safe or work (as there have been decades of failed efforts with this type of vaccine development and already reports of adverse reactions in the candidates. And why would COVID-19 stay around long enough for a vaccine to be relevant–which is a similar issue with the flu vaccine).
Also “testing” is not a medical intervention that helps anyone (we know about the false positives also but even so) and the method of testing was considered inappropriate by the inventor of the test-it was meant for engineering, not for diagnosis. And PPE has been turned into a lifestyle but how does it treat anybody who is ill? It should only be of concern to the medical profession. We’re supposed to obsess over medical supplies now and shortages of everything. Why? Because the whole world is being pushed into a rationing system.
So what is the priority? Testing, counting and tracking “cases” (human beings) (and generating fear even by talking about ventilators, for example) seems to be the only goal of this novel world order.
The rest of that paragraph is outrageous. It’s like the whole new COVID religion is represented in this one document by the CMA as if they couldn’t have written anything independently. The concept is “essential workers” which is the whole idea–there are some people who are essential and some people who are NOT! That’s what COVID is about also–rationing of all kinds, including not having employment for everything–replacing that with universal basic income. It’s not about a virus. It’s about getting us to accept that the only thing that matters is the “pandemic response”! Nothing else matters!? Cancer treatment? Food supply? Family life? The rest of the economy. These don’t matter? All of the propaganda of these past months is summarized in these documents.
It is an abuse in itself just to write in this way with an assumption about the value of certain lives being higher than others. There is NO reason to expect that there will not be abuses based on societal rank even WORSE under COVID than anything that has existed before. These are arbitrary definitions, as in dictated at the whim of those in power. That is not the system we have been used to. Ironically I would not want to be in the situation of “privilege” where I was first to be pushed onto a ventilator when I was short of breath or given a gene-altering “vaccine” that was never properly tested over any length of time. So nothing about the paragraph makes sense to me, especially with the dramatizing rhetoric. The religiosity of someone selling this new code of life with its fantasy-level hypocritical moralizing is off the charts.
This document is not unique. This is how the entire world of media, corporations and governments talk now. They all communicate in this gibberish to make us conform to this new system of thought and behavior.
“Saving others”–that’s what everybody does when they feed, clothe and provide for their FAMILIES and provide income (through the market) for farmers and medical workers of different kinds. Also, this is a religious concept–saving. It is not just a term we throw around casually–that’s why I say this is religious in tone. It’s a belief system.
We are all supposed to be helping each other, not just special professions. We don’t elevate just anybody in the world just because they are wearing a smock or a uniform or because they have important technical skills. That is absurd! This has been getting worse and worse, especially since 9/11 especially. There are very corrupt people in all walks of life. Human beings all have roles in life as humans. We shouldn’t elevate people to special positions of value and privilege to do all the “important” things–and this goes on to such a degree that we are inclined to bow in reverence and keep our mouths shut about all kinds of abuses. That is what is happening here. It is a special position of value they are pushing even further although it tries to say the opposite!
For patients with similar prognoses, equality should be invoked and operationalized through random allocation, such as a lottery, rather than a first-come, first-served allocation process. . . . treatments for coronavirus address urgent need, meaning that a first-come, first-served approach would unfairly benefit patients living nearer to health facilities. And first-come, first-served medication or vaccine distribution would encourage crowding and even violence during a period when social distancing is paramount. Finally, first-come, first-served approaches mean that people who happen to get sick later on, perhaps because of their strict adherence to recommended public health measures, are excluded from treatment, worsening outcomes without improving fairness. In the face of time pressure and limited information, random selection is also preferable . . . .
This academic term they are using is interesting: “operationalization.”
Notice that they say “equality should be invoked” to justify healthcare lotteries–because if you live next door to the hospital, that’s not fair? No, they just want to be able to not treat that person if they don’t fit their criteria. In a civilized, calm way of doing things, we take our turn. In this new system, we obey the all-knowing AI computer god. And of course there can be abuses–abuse will be more likely by privileged people hiding behind the computer algorithms. I doubt they would even be in the same system at all.
I don’t believe doctors wrote this document, they adopted this from another agency. “Social distancing” is inserted here along with the rest of the COVID narrative. That was some nonsense invented by oligarch-funded social engineers in order to take power away from us. That’s what is happening. “Social distancing is paramount” is a strange kind of value system to introduce to us. What a bizarre doctrine and it’s based on complete BS. If you find a medical basis for it, let us know. We have lived with many viruses, we’ve always lived with them. Most of us don’t get sick or die. They spread. Nobody stops them from spreading. We only ever quarantined sick people, not healthy people. This is insane. It’s a ploy to introduce this new system of control.
Crowding and “violence” is the Hollywood scenario presented. A lot of the language in this document is totally inappropriate. There are lot of screenwriters nowadays selling us on living in the COVID Brave New World, but I don’t think this “pandemic” story was ever particularly entertaining. Fear stories work for creating cults though and I had my experiences with fear of nuclear Armageddon when I was 13 years old, generated by a media-savvy cult. But it’s fear of everything all these years. It’s really mind-numbing. Fear of drought, fear of famine, fear of disease, fear of nukes, fear of population, fear of climate change, fear of terrorism. Endless loads of toxic BS wall to wall, day in day out–poisoning the minds of young people especially, manipulated through universities and politics.
There is so much implied in this paragraph. Notice the attempt to set off those who follow the public health guidelines very strictly against the situation where they might be excluded because they had to line up. That would be contrary to “fairness.”
So there is no pandemic emergency, the hospitals have been half empty for months. It was a lie. But these health care rationing policies are in place saying that lining up is unfair all of a sudden. People will get sicker if the economy gets worse and their food gets worse and there are less supplies of everything. I guess they want people phoning up from home to get a lottery-assigned appointment rather than lining up, talking to others and causing trouble. That’s why they want people social distancing and isolating in the first place. If they don’t like the time and place, they can blame the computer. Nobody to get angry at. Nobody to be held accountable. That’s what I think “AI” is after all is said and done. It’s just a technological cover for the elite to hide behind–the ones who created the algorithms in the first place–like this policy itself.
Prioritization guidelines should differ by intervention and should respond to changing scientific evidence. For instance, younger patients should not be prioritized for Covid-19 vaccines, which prevent disease rather than cure it, or for experimental post-or pre-exposure prophylaxis. Covid-19 outcomes have been significantly worse in older persons and those with chronic conditions. Invoking the value of maximizing saving lives justifies giving older persons priority for vaccines immediately after health care workers and first responders. If the vaccine supply is insufficient for patients in the highest risk categories —those over 60 years of age or with coexisting conditions —then equality supports using random selection, such as a lottery, for vaccine allocation. Invoking instrumental value justifies prioritizing younger patients for vaccines only if epidemiologic modeling shows that this would be the best way to reduce viral spread and the risk to others.
Why do they assume these vaccines are safe–especially for the elderly? What about the side effects of existing vaccines, and what about these new genetic vaccines that have never been approved before? Everybody should have the right to INFORMED consent, including the “essential” workers, the health workers and the elderly in institutional settings. They should ALL be informed of what the “vaccine” ingredients are, what it is supposed to do and what kinds of adverse reactions test subjects have experienced–and long-term use adverse reactions–but of course that information is going to be lacking. There are detailed official documents available for existing vaccines and many negative stories. It looks like there is already a lot of negative information available about these COVID-19 “vaccines” under development–just the whole idea of how they operate is one point of great concern–but the media doesn’t present the public with these concerns.
The vaccines concept is repeated often in this document because it’s a key part of the religion being pushed. There is no reason to think it is going to benefit us or be safe, or that it will ever exist in a usable form, but it is mentioned repeatedly as if it is of benefit to people and that special workers need to get it sooner, etc. I am very concerned about where this ends up.
Epidemiologic modeling is even more relevant in setting priorities for coronavirus testing. Federal guidance currently gives priority to health care workers and older patients but reserving some tests for public health surveillance could improve knowledge about Covid-19 transmission and help researchers target other treatments to maximize benefits.
They are still testing in August and the media and governments everywhere are still testing and discovering positive cases (almost half are false positive according to a public health official in Ontario). The more they test, the more “cases” they discover–mostly people with mild or no symptoms–the more they quarantine.
Conversely, ICU beds and ventilators are curative rather than preventive. Patients who need them face life -threatening conditions. Maximizing benefits requires consideration of prognosis —how long the patient is likely to live if treated —which may mean giving priority to younger patients and those with fewer coexisting conditions. This is consistent with the Italian guidelines that potentially assign a higher priority for intensive care access to younger patients with severe illness than to elderly patients. . . .
People who participate in research to prove the safety and effectiveness of vaccines and therapeutics should receive some priority for Covid-19 interventions. Their assumption of risk during their participation in research helps future patients, and they should be rewarded for that contribution. These rewards will also encourage other patients to participate in clinical trials. Research participation, however, should serve only as a tiebreaker among patients with similar prognoses.
It sounds like the trial subjects will have a position of privilege but, on the other hand, I wouldn’t want to be them. I see no reason to think that these products will be beneficial or helpful to anyone, and they are very likely to be harmful to many. The whole idea that it is necessary to have a vaccine is false. This is a complete distortion. These are products that could cause a lot of damage, just as other vaccines have done–and people don’t know about these events because they have been suppressed. Notice the collectivization, the call to service and sacrifice for the ultimate cause. This is a false religion. Our history is filled with these lies and the suffering that results.
There should be no difference in allocating scarce resources between patients with Covid-19 and those with other medical conditions. If the Covid-19 pandemic leads to absolute scarcity, that scarcity will affect all patients, including those with heart failure, cancer, and other serious and life-threatening conditions requiring prompt medical attention. Fair allocation of resources that prioritizes the value of maximizing benefits applies across all patients who need resources. For example, a doctor with an allergy who goes into anaphylactic shock and needs life-saving intubation and ventilator support should receive priority over Covid-19 patients who are not frontline health care workers.
So many rationalizations for privilege. We’ve had thousands of years developing ethics based on other values regarding human life. These sorts of policies thrown at us now, which nobody is even reading, are dubious and dangerous.
Long Term Care Home Analysis – Part 10 – CMA Document — No Comments
HTML tags allowed in your comment: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>