Advocates, ethicist renew call for triage protocols as Manitoba approaches 4th wave

Groups in Manitoba are reiterating their call for the province to establish and share formal rules to decide who will and won't get medical care if the pandemic again overwhelms the health-care system.

The request for triage protocols was made earlier this year when Manitoba's third wave of COVID-19 cases put such a strain on hospitals that dozens of critical care patients had to be transferred out of province for treatment.

David Kron, a spokesperson for the Human Rights Triage Protocol Coalition, has been among those asking for clarity about how decisions will be made if health-care resources become so strained that physicians are forced to choose between critically ill patients during a potential fourth wave.

The group of advocates sent a list of 17 recommendations to the province earlier this month, hoping to ensure that Manitobans will be given equal access to life-saving care during the pandemic, regardless of age, disability or other factors.

"When you have limited resources in a crisis, we don't want those decisions being made at the bedside by an exhausted doctor and an exhausted nurse," Kron said.

"We want it to be transparent, we want it to be informed and we want the staff to be trained on it."

After months of lobbying with no action from government on the issue, Kron said he's frustrated — especially as other provinces, including Ontario, Quebec and Alberta, bring in protocols of their own.

And as he watches a health-care system reach a breaking point two provinces over, Kron said he's worried about what could happen if Manitoba continues to drag its feet on creating triage rules and finds itself in a similar situation.

"Alberta is going through a massive crisis and we hope that we don't have that here in Manitoba, but we don't know. We can't predict the future," he said.

"It's just good planning, right? You write an emergency plan on how to get out of a burning building and you pray you never have to use it. But let's write the protocol."

Public trust crucial: ethicist

Last week, Manitoba's Chief Provincial Public Health Officer Dr. Brent Roussin said it's likely the province is at the start of another COVID-19 wave driven by increased spread in southern Manitoba. 

Medical ethicist Arthur Schafer said it's now critical that the province create triage protocols so it's prepared in case the fourth wave brings the kind of stress to the health-care system that the third one did.

He said leaving those decisions to individual doctors at the bedside puts a huge moral responsibility on those physicians and leaves open the possibility that life-and-death choices will be made arbitrarily, instead of according to objective criteria. 

"You may get arbitrary and inconsistent treatment from one hospital to another, from one doctor to another, as to who's to live and who's to die. I think that's unacceptable," Schafer said.

He said it's also crucial that triage protocols are released publicly and created after consulting with people in the general public — and particularly groups representing elderly and disabled people and people of colour.

"This is an important issue, and I think if you keep these guidelines secret, you promote cynicism. You undermine public trust," Schafer said.

In May of 2020, Shared Health published a pandemic medical ethics framework that called for a triage process to be created, but that still hasn't happened.

At the time, acting health minister Kelvin Goertzen said the province was focused on ensuring that every person is able to get the medical treatment they need by increasing ICU capacity and working with other provinces.

A spokesperson for current Health Minister Audrey Gordon did not respond to a request for comment on Sunday.