Tuesday, April 21, 2020

COVID-19 pandemic shines a light on medical ethics


John Wood, Order of New Brunswick recipient lives With Duchenne Muscular Dystrophy 
(Photo: Savannah Awde/Legislature Bureau]

Persons with disability across the globe have been keeping an eye on trends in various countries with regard to how clinicians on the front lines of the COVID-19 pandemic are treating, or in some cases, not treating persons with pre-existing disabilities that may impact survival.

Has this pandemic brought us to the point where a doctor might decide which life is more worth saving if one becomes infected with COVID-19? 

There’ve been various reports on social media that people with learning disability and older people with various comorbidities are having DNR orders applied to them with little discussion with family or other designated caregivers. Various reports out of Ontario and one document in particular, The Clinical Triage Protocol for Major Surge in COVID Pandemic, are disturbing at best. 

Robert Lattanzio, executive director of Ontario’s ARCH Disability Law Centre, a specialty legal clinic that practices exclusively in disability rights law, said the document provides three levels of triage for health-care providers based on demand and resources. Using the “frailty scale,” the framework doesn’t just look at who would benefit most from the care, but also calls on health professionals to consider factors like the quality of life of those with a disability, he said. “That is where we cross a line that we cannot cross,” he said.

How at risk of not receiving timely treatment are persons in nursing homes, group homes, independent living residences? Are GPs conferring with patients and encouraging the signing of DNR orders for those who are at greater risk of complications and death? I am inclined to think not.  

In fact, any anxieties I might have had have been assuaged, as Premier Blaine Higgs has assured citizens of New Brunswick that persons with disability will receive the same level of care as all others  with regard to treatment should they contract the COVID-19 virus. That is absolutely as it should be.
Will the COVID-19 pandemic bring about or force changes in attitudes as to how persons with disability, the frail and the elderly are treated? I certainly hope there are huge changes that will improve their lot in life. What I’d also like to see is universal basic income. Let’s just get that done. In other countries, it’s already been shown to break into the poverty cycle by allowing the poor and the working poor to accumulate a float/savings to support costs of improvements to quality of life and improved health.

In staying home, we are protecting others, notably the health and wellness of doctors and nurses who put their own lives on the line treating COVID-19 patients. The quality of the life of persons with disability is front and center as the health care community is focused on treating those infected with COVID-13. Many clinicians often have a years long relationship with patients who live with cerebral palsy, spina bifida, MS, MD, Parkinson’s, dementia and so on; they’ll be doing all that they can do to ensure quality care.

Recently, I received a letter from the Vice-President of our Extra Mural Program which outlines their protocols when making home visits. In the event that testing is required, the visiting clinician will arrange it. Since my last visits from Extra-Mural were rehabilitative in nature, I will not be requiring a consult as I have no active medical complaint that would require attention. I’m gratified to know that they are out there caring for patients during these challenging times.

As the days and weeks have passed during my confinement, I am really doing nothing differently than I had done before. Now, as then, my goal is to keep myself healthy by staying well hydrated and eating well. Given that there’s not been and will not be a lot of people traffic in my home, I am confident that my environment is safe.

It’s not likely that I will find myself in a position that so many persons with disability find concerning   — the ‘what if’ question that the pandemic poses with regard to treatment  should they become ill. Thankfully, we have the Human Rights Act that protects us broadly. Will it be taken narrowly in these times to ensure that, for example, the vent dependent, spastic quadriplegic child who presents with  a few symptoms of COVID-19 will receive the same level of care that a 12 year old non-disabled presenting with those same symptoms receives? Our Premier has ensured that it will. Persons with disability have nothing to fear.
Human rights, set down internationally, and put into our domestic law through the Human Rights Act, belong to every single person in the Canada, whether they have disabilities or not, whether they fall into COVID-19 vulnerability or not.

Such legal standards and protections will make it easier for medical care providers to do what they know they need to do. That being so, I am confident that families who are concerned about whether their relative with pre-existing, life altering disability can relax. Their loved one’s care will be equal access.  Sit. Stay. Safe.

Carla MacInnis Rockwell is a freelance writer and disability rights advocate living outside Fredericton, NB with her geriatric Australian silky terrier and a rambunctious Maltese. She can be reached via email at carmacrockwell@xplornet.ca

Tuesday, April 7, 2020

Confinement during COVID-19


From the Chez Rockwell Kitchen: Cream of Asparagus with Salmon Soup
with Toasted Herb Bread
(recipes available upon request)

A recent email from the Iowa cousin: “You have years of experience in self isolation. I consider you somewhat of an expert in this area. Have you considered writing an article instructing newbies the best procedures to follow? With so many world wide now requested to self isolate, you could be a very valuable guide for their safe  survival.”

Wow! It’s official I’m an expert on the hermit life! Who woulda thunk that my bulk buying, bulk baking and cooking would come in so handy and actually be quite necessary tools to my continued health and wellness during these past weeks and going forward.

  No, I don’t have a stockpile of toilet paper in the spare bedroom, so don’t even bother thinking about showing up at my door with your hand out! What you can do, though, if you do go out and about from time to time, is to check on neighbours. Most city dwellers have a mailbox beside their front door, so leave a note, offering to collect a few essentials if they need them. It’s a great way to get to know those who have been isolated for years and you never knew. 

Prior to these very serious and yes, deadly times, I didn’t ‘self-isolate’ in any real sense that suggests I am a hermit. Admittedly, I do enjoy being alone but I also enjoy being out and about. Alas, I don’t drive and after the death of my husband in 2007, I relied upon the generosity of neighbours to include me on outings to the city when their own schedules allowed. Sometimes, a few neighbours would actually make themselves available to take me to Fredericton to pick up groceries at Victory; groceries that were waiting for me because, for years, the kind staff there have done my shopping based on an email I would send them a few days before I showed up at the market. I cannot thank them enough for their generosity. No doubt you’ve read about their expanded services during COVID-19. They are owed a huge thank-you, people! They’re making the lives of seniors and shut-ins so much safer. 

I’m glad my bulk shopping has not been a problem for one friend who has been amazingly support of my needs. Sometimes, the dogs are with us, crated, to be dropped off at the groomer — on those occasions, I can’t get a lot of groceries. My current wheelchair won’t fit in the back seat as my old one did. Accommodating my needs within the parameters of my disability poses some challenges particularly as my friend is older than I and I cannot help her get the chair in the trunk; I feel like such a slug at time, but she reassures me that she’s happy to help. Before we left the city, we’d swing by Victory to grab the grub and hit the road to booniesville. For now those outings are on hold.

For those with children who are singing that ‘I’m bored, Mom’ song, consider turning this isolation time into something like the Olympic Games. Organize the days based on things each person in the home is good at and enjoys doing so that everyone will have his/her day. Hold a competition to see who’s prepared the best dinner meal. For younger children, turn baking and cooking into a reading and math lesson. Yes, it’s do-able with a bit of creativity. I’ve come across many articles about folks actually embracing home baking and cooking. What is sort of sad really is the number of young adults who actually don’t know how to cook. It wasn’t  part of their growing up the same as it was for me and others of my generation. Now is their time to shine, learning how to make an exquisite braided bread, baked to perfection. Hey, that’s an idea. Home made pizzas with a medal awarded for the most creative. Pizza dough is really easy to make and is weird topping friendly. Get in touch and I’ll give you my favourite dough recipe.

Try to keep to a routine of personal care and go with 3 different sets of PJs - your work at home jam-jams, a  pair for when you’re curled up on the couch binge watching favourite shows, and the ever popular ‘I’m stylin’ in my dinner at the table jammies’. Don’t become a total slob. That’s so unbecoming.

Remember! If you don’t HAVE to go out, STAY IN. Lives depend on the co-operation of EVERYONE during these trying times. Binge watch BritDrams; Darling Buds of May and Rosemary and Thyme are very good.

Take care and be well, all.
Carla MacInnis Rockwell is a freelance writer and disability rights advocate living outside Fredericton, NB with her geriatric Australian silky terrier and a rambunctious Maltese. She can be reached via email at camacrockwell@xplornet.ca