The Impact of Disability: A Comparative Approach to Medical Resource Allocation in Public Health Emergencies

It is a matter of time before the next widespread pandemic or natural disaster hits the United States (U.S.). The international response to the 2009 H1N1 influenza stands as a cautionary tale about how prepared the world is for such an emergency. Although the pandemic fortunately proved to be less severe than initially anticipated, it nevertheless resulted in shortages of medical equipment, overburdened hospitals, and preventable patient deaths, particularly among young people. A pandemic will inevitably lead to difficult decisions about the allocation of medical resources, such as who will have priority access to ventilators and critical care beds when demand exceeds supply. We previously evaluated the protocols public health and medical organizations have promulgated to guide allocation decisions in a public health emergency. We concluded that many of these protocols violate U.S. law and ethics with respect to people with disabilities, because they exclude some people with disabilities from receiving care altogether or because of a need for prolonged use of resources, poor “quality of life,” or limited long-term prognosis. Because the legal and social status of people with disabilities is tied to underlying societal attitudes toward impairments, cultural differences between populations may lead to significantly different distributive outcomes. In this paper, we examine other countries’ approaches to the allocation problem in public health emergencies, both to identify other approaches to these challenging problems and to provide insight into how to develop more equitable policies to guide allocation decisions during a public health emergency in the U.S