We insist that the elderly receive proper and effective medical treatment.
As the weather becomes colder and economy weaker, we should be aware of the dangers faced by the elderly in Ontario and other provinces from the morally unacceptable health care rationing (“life boat ethics”) policies introduced by governments in the spring.
Health care practitioners, administrators and public officials should renounce these immoral policies in light of sections in the Criminal Code and Canadian Charter of Rights and Freedoms.
Everyone should actively share this information with doctors, nurses, hospitals, seniors’ homes, officials of all kinds, community and religious leaders, business owners and members of the public.
It is a total contradiction for people to praise governments for obsessing over the spread of COVID-19 after governments deliberately set new policies that refused care to the elderly and placed them in situations where they were much more likely to be infected and neglected.
Toronto Star, “Ontario developing ‘last resort’ guidelines on which patients to prioritize if hospitals are overwhelmed by critical COVID-19 cases,” March 29, 2020 (https://www.thestar.com/news/canada/2020/03/29/ontario-developing-last-resort-guidelines-on-which-patients-to-prioritize-if-hospitals-are-overwhelmed-by-critical-covid-19-cases.html)
- “The provincial government has developed a “triage protocol” for doctors who may soon be forced to make ethically fraught decisions over how to ration critical care beds …”
- “long-term-care patients who meet specific criteria will also no longer be transferred to hospitals.”
Government of Canada, “COVID-19 pandemic guidance for the health care sector,” 2020-04-22 (https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/covid-19-pandemic-guidance-health-care-sector.html)
- “LTC [long term care] facilities may also be asked to provide surge capacity for hospitals through admission of non-COVID-19 hospital patients . . .”
- “If COVID-19 does develop in LTC facility residents, they should be cared for within the facility … to preserve hospital capacity . . . ”
- “… resource allocation decisions including prioritization of patient access to scarce resources including acute care, critical care, oxygen support, ventilator support, and extracorporeal membrane oxygenation (ECMO) support. If patients are not eligible … they should be provided with palliative care and/or pain management.”
Canadian Medical Association Policy: Framework for Ethical Decision Making During the Coronavirus Pandemic,” April 2020 (https://policybase.cma.ca/en/viewer?file=%2Fdocuments%2FPolicypdf%2FPD20-03.pdf).
- “… insufficient resources, difficult decisions have to be made about who receives critical care (e.g., ICU beds, ventilators) . . . .”
- “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 [https://www.nejm.org/doi/full/10.1056/NEJMsb2005114].
- “… the CMA recommends that triage teams or committees be convened … in order to help separate clinical decision making from resource allocation, thereby lessening the moral burden being placed on the individual physician.”
- “The CMA recommends that physicians receive legal protection to ensure that they can continue providing needed care to patients . . . without fear of civil or criminal liability or professional discipline . .”
- “…giving priority to those who are worst off in the sense of being at risk of dying young and not having a full life”
- “…. withdrawing ventilators or ICU support from patients … to save those with better prognosis will be extremely psychologically traumatic for clinicians …”
- “Maximizing benefits requires consideration of prognosis . . . 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.”
Ontario Ministry of Health Directives – Memos: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/dir_mem_res.aspx
- Transfer of Hospital Patients and Community Clients to Long – Term Care Homes, April 29, 2020
- Transfer of Hospital Patients to Retirement Homes April 23, 2020
- Temporary Pause on Transitioning Hospital Patients to Long – Term Care and Retirement Homes, April 15, 2020
- Use of Hotels and Retirement Homes, April 2, 2020
- Ramping Down Elective Surgeries and Other Non – Emergent Activities, March 15, 2020
CBC, “‘No benefit’ to sending seniors ill with COVID-19 to hospital, some nursing homes tell loved ones,” April 3, 2020 (https://www.cbc.ca/news/health/covid-19-long-term-care-1.5519657)
- “‘She would be denied emergency transfer in the event that she was deathly ill from COVID.’”
- “She would be denied access to an ICU. She would be kept in the care facility ….”
- The family was pressured to change her status from life-saving treatment to “Do Not Resuscitate.”
- A letter “sent to a family member by a long-term care facility in Ottawa says residents who get sick with COVID-19 will stay where they are.”
The Globe and Mail, “How shoring up hospitals for COVID-19 contributed to Canada’s long-term care crisis,” May 21, 2020 (https://www.theglobeandmail.com/canada/article-how-shoring-up-hospitals-for-covid-19-contributed-to-canadas-long/).
- An 86-year old patient who died after being discharged from hospital “was one of thousands of seniors discharged to nursing and retirement homes as Ontario, Quebec and other provinces rushed to clear beds …”
- “…some hospitals, physicians and long-term care facility administrators were discouraging families from sending infected nursing-home residents to the hospital, saying little could be done to effectively treat COVID-19 in patients who were old and chronically ill.”
- “… most of the nursing- and retirement-home residents who have succumbed to COVID-19 in Canada died inside the virus-stricken, understaffed facilities, while many of the hospital beds opened for coronavirus patients sat empty.”
- “. . . Jane Meadus, a lawyer with the Advocacy Centre for the Elderly in Toronto: ‘. . . had they moved people out [of nursing homes] when they became aware they were COVID-positive, they might have been able to slow or stop the infections from continuing through the homes.’”
- In March, the Quebec government told hospitals to do “load shedding” by postponing procedures and transferring patients.
- Ontario transferred 2,200 patients from March 2 to May 3 (to LTC and retirement homes).
The Globe and Mail, “Nine residents die, 34 staff suffer symptoms as coronavirus devastates Bobcaygeon, Ont. nursing home,” March 29, 2020 (https://www.theglobeandmail.com/canada/article-covid-19-kills-nine-infects-34-staff-at-bobcaygeon-nursing-home/).
- This story is an example of how the administrator actively discouraged families from sending elderly residents to the hospital if they became sick.
Go to “Coronavirus disease 2019 (COVID-19): Epidemiology update” (https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html) and scroll down to “Figure 4…” (Dates given for September 24, 2020).
- As the age increases, the number of deceased increases substantially (Canada-wide: 80+ is 6,557 or 71.3% of the “COVID-19” deaths), and the number of hospitalized increases. However, “admitted to ICU” starts dropping off at 70-79 (23.1% of those admitted to ICU) and drops even lower for age 80+ (11.6% of those admitted to ICU).
The Globe and Mail, “Ontario coroner investigates COVID deaths in care homes, but can’t confirm if inquests are needed,” May 18, 2020 (https://www.theglobeandmail.com/canada/article-ontario-coroner-investigates-covid-deaths-in-care-homes-but-cant/)
- “George Morrison .. . . died a week after he was sent to hospital with apparent anorexia, dehydration, a urinary tract infection and symptoms of COVID-19, said his daughter …” “Ms. Morrison asked Ontario’s chief coroner to investigate her father’s death because of her concerns that he was not being properly fed and cared for because of the home’s low staffing levels during the COVID-19 outbreak.”
Montreal Gazette, “Analysis: How Montreal’s CHSLDs mirrored the Diamond Princess outbreak,” May 14, 2020 (https://montrealgazette.com/news/local-news/analysis-how-montreals-chslds-mirrored-the-diamond-princess-outbreak/)
- “Here in Quebec, and especially in Montreal, it has become clear that our . . .long-term care centres (CHSLDs) have also become incubators for the coronavirus. . .”
- “. . . authorities in Quebec were late in transferring residents out of CHSLDs. They did so only after many fell ill, moving them to acute-care hospitals . . . .Some of those residents were malnourished and dehydrated.”
Ministry of Health, “COVID-19 Outbreak Guidance for Long-Term Care Homes (LTCH) Version 1,” April 1, 2020 (https://web.archive.org/web/20200406203248/http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/LTCH_outbreak_guidance.pdf).
- This document describes extreme isolation and screening procedures and how they applied to staff and visitors (see pages 2 and 7). I think these had a severe impact on the residents by inevitably contributing (through fear and quarantine) to low staff and visitor levels, and residents being neglected as a result.
FAO Financial Accountability Office of Ontario, “Ontario Health Sector: A Preliminary Review of the Impact of the COVID-19 Outbreak on Hospital Capacity,” Apr 28, 2020 (https://fao-on.org/en/Blog/Publications/health-2020).
- Lead-up to the COVID-19 outbreak: Ontario had 906 acute care beds, 357 critical care beds unoccupied. By April 14, “measures that made available an additional 9,349 acute care beds, 2,077 critical care beds …, including: Cancelling elective surgeries and other measures taken to free-up existing beds (including moving existing hospital patients to alternative places of care) resulted in the availability of 7,849 acute care and 585 critical care beds …”
CTVNews.ca, “‘All of our rooms are empty’: Hospital ERs vacant during pandemic,” April 29, 2020 (https://www.ctvnews.ca/health/coronavirus/all-of-our-rooms-are-empty-hospital-ers-vacant-during-pandemic-1.4918208).
- “… more than 11 thousand unoccupied beds in hospitals across Canada, … fewer ER visits … a staggering number of surgeries — almost 53 thousand — have been cancelled.”
The Ontario government’s use of the Emergency Management and Civil Protection Act was invalid: (https://www.ontario.ca/laws/statute/90e09#BK12)
- 7.0.1 (3) lists two criteria that failed to be met: There wasn’t an emergency that required immediate action to prevent a danger of major proportions and there wasn’t a lack of resources. There was a huge surplus in hospital beds.
- 7.0.2 (1) says that emergency orders should be constrained by the Charter: “The purpose of making orders under this section is to promote the public good by protecting the health, safety and welfare of the people of Ontario in times of declared emergencies in a manner that is subject to the Canadian Charter of Rights and Freedoms.”
- 7.0.2 (2) says that an emergency order has to alleviate harm or damage and that making an order has to be a reasonable alternative.
- 7.0.2 (3) says the orders should be limited, in intrusiveness, for example.
- None of these conditions were met and unnecessary damage was done to peoples’ lives.
Some relevant sections of the Canadian Charter of Rights and Freedoms everyone should follow up on (https://laws-lois.justice.gc.ca/eng/const/page-15.html#h-39):
- 2. “Everyone has the following fundamental freedoms: (a) freedom of conscience and religion; (b) freedom of thought, belief, opinion and expression, including freedom of the press and other media of communication; (c) freedom of peaceful assembly; and (d) freedom of association.”
- 7. “Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof …”
- 9. “Everyone has the right not to be arbitrarily detained or imprisoned.”
- 12. “Everyone has the right not to be subjected to any cruel and unusual treatment or punishment.”
- 24. (1) “Anyone whose rights or freedoms, as guaranteed by this Charter, have been infringed or denied may apply to a court of competent jurisdiction …”
These parts of the Criminal Code (https://laws-lois.justice.gc.ca/eng/acts/C-46/FullText.html) should be pursued by police, judges and legal professionals as a response to health care rationing policies:
- 215 (1) Every one is under a legal duty
. . .
(c) to provide necessaries of life to a person under his charge if that person
(i) is unable, by reason of detention, age, illness, mental disorder or other cause, to withdraw himself from that charge, and
(ii) is unable to provide himself with necessaries of life.
(2) Every person commits an offence who, being under a legal duty within the meaning of subsection (1), fails without lawful excuse to perform that duty, if
. . .
(b) with respect to a duty imposed by paragraph (1)(c), the failure to perform the duty endangers the life of the person to whom the duty is owed or causes or is likely to cause the health of that person to be injured permanently.
- 222 (1) A person commits homicide when, directly or indirectly, by any means, he causes the death of a human being.
. . .
(5) A person commits culpable homicide when he causes the death of a human being,
(a) by means of an unlawful act;
(b) by criminal negligence;
(c) by causing that human being, by threats or fear of violence or by deception, to do anything that causes his death; or
(d) by wilfully frightening that human being, in the case of a child or sick person.
- 224 Where a person, by an act or omission, does any thing that results in the death of a human being, he causes the death of that human being notwithstanding that death from that cause might have been prevented by resorting to proper means.
More details: http://canadianliberty.com/revised-stop-death-panels-what-happened-with-health-care-rationing-in-the-spring/ and more information on COVID-19: http://canadianliberty.com/covid-19-summaries-and-resources/