Phychogeriatrics誌のコメンタリーで触れられていたガイダンスに関する記事を読んでみた。
2022年3月4日の記事
米各州がパンデミックにおける医療ひっ迫の際の医療資源分配をめぐってガイドラインについては、2020年にいくつかの州で障害者を違法に差別するものだとの苦情申し立てが相次ぎ、保健福祉省と公民権局（OCR)が、アラバマ、ノースカロライナ、ペンシルベニア、テネシーとユタの各州で和解させたほか、テキサス州の関連機関との苦情解決、コネチカット州では障害のある人の面会制限についての苦情解決にかかわるなど、乗り出した。
こうした事態を受け、このたびOCRから医療的危機状況においても障害のある人の公民権保護の法的重要性明確にするため、医療職向けにガイドラインが出された。
FAQの形で出されたガイダンスの当該部分では、医療資源の分配に次を考慮に入れることについて、いずれもＮＯと回答されている。
- Whether an individual with a disability or an individual who is likely to have a disability after treatment will have a lower quality of life or relative worth to society compared with an individual without a disability who also requires treatment.
障害のある人または、治療後に障害をもつことになると見込まれる人は、治療を必要としている障害のない人に比べて、ＱＯＬが低かったり、社会にとっての価値が相対的に低いかどうか。
- Whether they can provide healthcare or deny a resource to an individual with a disability who has COVID-19 if it may require more of the resource than treating individuals without disabilities for COVID-19.
障害のある感染者は障害のない感染者より治療に余計な資源を必要とする可能性があるかどうかによって、医療を提供するか、拒否するかを決める。
- Whether they can consider that an individual with a disability may not live as long as an individual without a disability after treatment.
治療後に障害のある人は障害のない人ほど長生きしないかのうせいがあることを考慮に入れる。
ちなみに、
ガイダンス原文はこちら。
面会制限に関する箇所は以下。
具体的なリスクアセスメントに基づいての面会制限は、終末期の限定的な例外を除き、公民権の侵害には当たらないとしつつ、コミュニケーションや意思決定の支援等、適切な医療を受けるために必要な場合には、個々の障害者のニーズにより適宜、個別に対応すべき、としている。
Application of Section 504 and Section 1557 to Visitation Policies
8. Many acute care and long-term care settings have restrictions on visitors, limiting entrance to patients, residents, and personnel with limited exceptions for end-of-life situations. How do Section 504 and Section 1557 apply to such restrictions?
During the COVID-19 public health emergency, some hospitals developed stricter visitation policies or started to enforce existing visitation policies they had not earlier enforced, because of a concern that anyone visiting the hospital could pose an additional risk of COVID-19 to patients and staff. In general, such restrictions are permissible under Section 504 and Section 1557 if those restrictions are in place for safety reasons based on objective risks. However, where these policies do not account for the needs of people with disabilities, they may result in unequal care and violate Section 504 and Section 1557. For example, when a patient’s disability prevents them from providing their medical history or understanding medical decisions or directions, the medical provider should explore whether a modification to its visitor policy may be safely carried out.
Reasonable modifications to visitation policies
Some people have disabilities that prevent them from providing their medical history or understanding medical decisions or directions. Permitting a patient or resident with a disability to use a support person when necessary to have an equal opportunity to obtain and benefit from healthcare services is a reasonable modification that generally must be provided unless it would fundamentally alter the nature of the service, program, or activity or impose an undue financial and administrative burden. For example, a hospital may be required to allow a support person to participate in a consultation so the support person can explain the information exchange in simple, understandable language to the patient, and ensure that the provider has the information necessary to treat the patient. Whether a covered entity must allow the support person to be physically present as a reasonable modification depends on a number of factors, including safety issues and whether remote participation would be effective.
In some situations, a covered entity will be able to meet its obligation to provide a reasonable modification by enabling a support person to communicate remotely with a patient (by voice or video phone calls) when needed by the individual with a disability. In others, the support person will not be effective unless present in person, because of the nature of the individual’s disability or the type of service provided by the support person, or for other reasons. Where the individual is entitled to an in-person support person, covered entities should take necessary steps to allow the support person to be present when needed. Such steps may include modifying visiting hours and visitation restriction policies.18
Legitimate safety requirements
Section 504 and Section 1557 allow covered entities to have legitimate requirements necessary for the safe operation of their services, programs, or activities. However, covered entities must ensure that their safety requirements are based on actual risks, not on mere speculation, stereotypes, or generalizations about individuals with disabilities.19 Covered entities can therefore require support persons and interpreters to comply with safety requirements, such as requiring them to participate in temperature checks and other screening measures and to use Personal Protective Equipment (PPE), and can refuse entry to individuals who refuse or fail to meet these requirements.
In addition, the use of a designated support person by an individual with a disability for decision-making and tasks other than effective communication does not eliminate the responsibility of the setting to ensure effective communication and provide appropriate auxiliary aids and services to individuals with disabilities when necessary to provide effective communication. Covered entities are required to take steps to ensure that their communications with people with disabilities are as effective as communications with others, except where a covered entity can show that providing effective communication would fundamentally alter the nature of the program or activity in question or would result in an undue financial or administrative burden on the covered entity. 20 Covered entities must provide appropriate auxiliary aids and services, such as alternative formats and sign language interpreters, where necessary for effective communication.21
