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Crisis Standards of Care in Idaho - It's Time to do Better

One person caring about another represents life’s greatest value
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By Lupe Wissel, AARP Idaho state director

Imagine having to be admitted to a hospital and to have your age be one of the deciding qualifiers to receive care. That’s the scenario in Idaho right now. Recently, the Idaho Department of Health and Welfare took the unprecedented step of using age to determine whether someone will receive hospital care.  By activating “crisis standards of care”, a state agency charged with protecting public health, is now allowing hospitals to pick and choose who will get treatment and who will not.

On behalf of our nearly 185,000 members across Idaho, we recognize these are some of the most difficult and challenging times we’ve faced but there is no doubt the Patient Care Strategies for Scarce Resource Situations unfairly uses age discrimination to ration care. Instead, we believe those entrusted with making health care decisions at state and local levels should be guided by current science and the clinical needs of individual patients and not a discriminatory crisis plan created last year. 

Using the categories of age to determine whether someone receives care is wrong. Plain and simple. The estimation of potential “life years” an individual has does not equate to the value of a life. Not only are all lives worth saving but there is no way one can compare an individual’s value to society, family and self-based on number of years.

By way of background, the current plan provides a framework for the development and implementation of crisis standards of care, to be applied in responding to public health emergencies that have the potential to overwhelm the health care system. It establishes the guiding ethical principle that “all lives have value and that no patients will be discriminated against on the basis of disability, race, color, national origin, age, sex, gender, or exercise of conscience and religion.” AARP fully agrees with this framework, as we believe guidelines must not discriminate against older persons, persons with disabilities, those with lower incomes, the uninsured, and individuals from other historically disadvantaged groups.

The Patient Care Strategies for Scarce Resource Situations, however, departs quickly and astoundingly far from this ethical framework. Without going into detail, page 8 clearly sets forth recommendations for resolving “ties” using age. I invite you to read it for yourself. We firmly believe that if two people need medical care a tiebreaker decision must not be based on age, race, disability, income, or other nonclinical factors, but on an individualized assessment of the patient and his or her circumstances as well as the objective medical evidence presented at the time.

As such, we are calling on the Idaho Department of Health and Welfare to consider the following recommendations and fix what is obviously broken.

First, remove any tiebreakers or decisions based on age. This is obvious and it is incomprehensible that it’s even included to begin with.  In fact, a March 28, 2020 Bulletin from the U.S. Department of Health and Human Services’ Office of Civil Rights makes clear that care should not be denied on the basis of stereotypes, quality of life assessments, or judgments about a patient’s relative worth based on disability or age. The bulletin also required providers to make decisions about treatment based on “an individualized assessment of the patient based on the best available objective medical evidence.”

Second, we are asking for clarification about the inconsistency in the state’s overall ethical framework and the tiebreakers for critical care resources and ventilators, as well as updated written guidance to remove the tiebreakers that are based on age from all crisis standards of care documents.

It’s time to do what’s right.

The Governor has called the move to implement these guidelines “an unprecedented and unwanted point in the history of our state.” We recognize how difficult the decision it is in implementing this plan, but we believe a difficult situation should not be made worse by using age as a tiebreaker.

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