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ethics

How Covid-19 exposed a deep medical ethics problem irrespective of an individual’s general
health and survival chances.
The statement called for all NHS staff to
be guided by certain principles: that
treatment decisions should not be
influenced by how disabled people are
valued by wider society; existing health
conditions unrelated to survival chances
should not figure in treatment decisions;
and being in receipt of social care and
having support needs should not make
health staff think that an individual would
not benefit from treatment.
The statement also called for people
with disabilities and their advocates to be
involved in their own treatment decisions.

Doctors on the defence
This alarmed doctors’ trade union the Attending to a patient on a ventilator: the British Medical Association says disability is relevant if it
British Medical Association (BMA) enough means a patient is significantly less likely to survive complex, demanding treatment
to rush out a statement that emphasised
“neither age nor disability are in disabilities. It may be some time before Down syndrome, until the last day of
themselves relevant criteria for making we have a clear picture. pregnancy. The ongoing scandal of unjust
decisions about treatment”. A report from Public Health England in long-term incarceration of more than
The statement acknowledged that at November found that, between February 2,000 people with learning disabilities in
some point demand for lifesaving and June, the overall number of deaths of assessment and treatment institutions,
treatment might outstrip the supply of people with learning disabilities were 2.3 often with abusive consequences, is a
available resources, in which case very times higher than they had been a year medically led scandal and it is the
difficult decisions would have to be made. previously. As yet, there is no detailed Department of Health and Social Care and
Nonetheless, the BMA emphasised that explanation of what caused that spike. its previous incarnations that have
its Covid-19 – Ethical Issues. A Guidance The Care Quality Commission was manifestly failed to tackle the situation.
Note states “someone with a disability recently asked to review the use of The litany of ongoing and historical
should not have that disability used by “do not attempt cardiopulmonary scandals demonstrate why there is such a
itself as a reason to withhold treatments”. resuscitation” decisions within all groups deficit of trust in the medical profession
However, it added: “Where the during the pandemic. It will be some time on the part of people with learning
consequences of… a pre-existing before that report is published. disabilities and their families.
disability… mean that the patient is Of course there are many first-rate,
significantly less likely to survive this supportive and empathetic clinicians. But
complex and demanding treatment, then The alarm the guidance raised there are also those who are not and, as an
it becomes a relevant factor.” among people with learning entity, the medical profession has always
The original ethics guidance note itself, had and still has an uneasy relationship
which the BMA had felt compelled to clarify, disabilities and their families with the learning-disabled community.
emphasises that some health professionals did not erupt suddenly These ethical failings by the medical
may, during this crisis, be obliged to profession, which have disturbing and
withdraw treatment from some patients to because of the pandemic sometimes devastating real-life

enable treatment of others who are more consequences for people with learning
likely to survive, and that it is lawful and disabilities and their families, have to be
ethical for doctors to refuse potentially However, whatever the CQC finds, the addressed and rectified.
life-saving treatment in such situations. alarm that the BMA guidance raised This is not a simple matter of rewriting
The presence of “comorbidities” (more among people with learning disabilities some guidelines. It will involve a cultural
than one illness or condition occurring in and their families and supporters was not attitude change across the profession and
one person at the same time) “may something that suddenly erupted in 2020 the NHS at every level.
sps1955; US Navy Page; both Wikimedia Commons profession throughout the crisis, the BMA establishment places on the lives of ethical black hole when they encounter
exclude individuals from eligibility”, even if
because of the pandemic.
To achieve this, we will first need to
It was deeply rooted in years of mistrust understand why people with learning
treatment for Covid-19 had already started.
The overall aim of the medical
disabilities so often disappear into an
of the value that the medical
people with learning disabilities.
the world of medicine.
guidance document stated, would be on
Both the law and ethical practice within
“delivering the greatest medical benefit to
To find the origins of this ethical
problem, we will need to search the past
medicine afford numerous examples of a
the greatest number of people”.
lower value being placed on the life of a
and understand how it still forms and
drives the opinions of thinkers who shape
No explanation for rise in deaths
learning-disabled person than on the lives
ethical policy and practice today. That will
of others.
We are yet to know the full health impact
of the pandemic and of medical practice
be the subject of the second article in this
UK abortion law allows termination of
during it on people with learning
series in the next issue. n
www.cl-initiatives.co.uk an abnormal foetus, such as one with Community Living Vol 34 No 2 | Winter 2021 23