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Deprecated: Implicit conversion from float 243.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 S+Afr+Med+J 2020 ; 110 (12): 1172-1175 Nephropedia Template TP
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Age discrimination in critical care triage in South Africa: The law and the allocation of scarce health resources in the COVID-19 pandemic #MMPMID33403960
Erasmus N
S Afr Med J 2020[Nov]; 110 (12): 1172-1175 PMID33403960show ga
No one may be refused emergency medical treatment in South Africa (SA). Yet score-based categorical exclusions used in critical care triage guidelines disproportionately discriminate against older adults, the cognitively and physically impaired, and the disabled. Adults over the age of 60, who make up 9.1% of the SA population, are most likely to present with disabilities and comorbidities at triage. Score-based models, drawn from international precedents, deny these patients admission to an ICU when resources are constrained, such as during influenza and COVID-19 outbreaks. The Critical Care Society of Southern Africa and the South African Medical Association adopted the Clinical Frailty Scale, which progressively withholds admission to ICUs based on age, frailty and comorbidities in a manner that potentially contravenes constitutional and equality prohibitions against unfair discrimination. The legal implications for healthcare providers are extensive, ranging from personal liability to hate speech and crimes against humanity. COVID-19 guidelines and score-based triage protocols must be revised urgently to eliminate unlawful discrimination against legally protected categories of patients in SA, including the disabled and the elderly. That will ensure legal certainty for health practitioners, and secure the full protections of the law to which the health-vulnerable and those of advanced age are constitutionally entitled.
|*Constitution and Bylaws[MESH]
|*Practice Guidelines as Topic[MESH]
|Aged[MESH]
|Aged, 80 and over[MESH]
|Ageism/*legislation & jurisprudence[MESH]
|COVID-19/*therapy[MESH]
|Critical Care/*legislation & jurisprudence[MESH]
|Health Care Rationing/*legislation & jurisprudence[MESH]