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Social Injustice in Health Care Access

June 23, 2020

By Christine Gebhard, Chief Executive Officer, North Country Community Mental Health

I’ve given a lot of thought lately to the ideal of social justice, given the civil unrest in our country over the death of George Floyd and countless others who experience social injustice.

On April 29, Governor Whitmer signed Executive Order 2020-64, to reaffirm the state’s commitment to equitable access to health care in the event demands for critical health care resources exceed availability. The order affirms the right to receive medical care without discrimination based on stereotypes, assessments of quality of life, or judgments about a person’s relative “worth” based on the presence of disabilities or other factors.

That this Executive Order was made is commendable; that it HAD to be made is shameful. It is an injustice that the 40 million Americans with disabilities can have very different experiences with the healthcare system than people without disabilities; often being treated dismissively or denied needed care and equipment. Historically, in this country, inequities in healthcare have included eugenics, institutionalization, medical experimentation, abuse and neglect, based solely on myths, stereotypes and the premise that people with disabilities are of less value.

Currently, this is manifesting in states’ crisis care policies as criteria for allocation of resources in the event of scarcity for treating COVID-19. Some policies explicitly include rationing care at the expense of people with loss of physical ability and cognitive limitations who would be relegated to outpatient, palliative care. Some policies even propose removing ventilators from people using them for chronic conditions to give to others who better meet the criteria for recovery from COVID-19. This is a chilling reminder of the slippery slope when faced with deciding who lives and dies and a good reminder why we enacted the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, and the Affordable Care Act to protect the civil rights of people with disabilities. These laws are being cited in complaints filed against these same states’ crisis of care policies that have placed people at the end of the line simply because of their disability.

Life or death decisions cannot be based on bias and stereotype, defined category, or other demographics. Access to care and limited resources must be ethical decisions based on the foundational principle of the equality of all human life. Access should be a clinical decision done on a case-by-case basis, regardless of race, nationality, gender, disability, or other personal details. Only then do we reflect our human values of dignity and respect for all people.

North Country Community Mental Health is dedicated to fostering mental health, recovery, and healing. This is not possible for us to achieve without acknowledging the pain, strife and social inequities so evident in our country today. As an organization, and as people dedicated to social justice, we must strive to maximize the voices of those who are oppressed or who cannot speak for themselves. We know, too well, the chronic and generational effects of trauma on the individual, a family, a community. Weshould not, we cannot remain silent.

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