Honorary Lecturer in Health Law, Unit for Undergraduate Medical Education, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2020 Nov 5;110(12):1172-1175. doi: 10.7196/SAMJ.2020.v110i12.15344.
No one may be refused emergency medical treatment in South Africa (SA). Yet score-based categorical exclusions used in critical care triage guidelines disproportionately discriminate against older adults, the cognitively and physically impaired, and the disabled. Adults over the age of 60, who make up 9.1% of the SA population, are most likely to present with disabilities and comorbidities at triage. Score-based models, drawn from international precedents, deny these patients admission to an ICU when resources are constrained, such as during influenza and COVID-19 outbreaks. The Critical Care Society of Southern Africa and the South African Medical Association adopted the Clinical Frailty Scale, which progressively withholds admission to ICUs based on age, frailty and comorbidities in a manner that potentially contravenes constitutional and equality prohibitions against unfair discrimination. The legal implications for healthcare providers are extensive, ranging from personal liability to hate speech and crimes against humanity. COVID-19 guidelines and score-based triage protocols must be revised urgently to eliminate unlawful discrimination against legally protected categories of patients in SA, including the disabled and the elderly. That will ensure legal certainty for health practitioners, and secure the full protections of the law to which the health-vulnerable and those of advanced age are constitutionally entitled.
在南非，任何人都不得被拒绝紧急医疗救治。然而，在危重病分诊指南中使用的基于评分的类别排除法不成比例地歧视老年人、认知和身体受损者以及残疾者。占南非人口 9.1%的 60 岁以上成年人在分诊时最有可能出现残疾和合并症。基于国际先例制定的评分模型在资源有限的情况下，如在流感和 COVID-19 爆发期间，拒绝这些患者进入 ICU。南部非洲重症监护学会和南非医学协会采用了临床虚弱量表，该量表根据年龄、虚弱程度和合并症逐渐拒绝将患者收入 ICU，这可能违反了宪法和禁止不公平歧视的平等禁令。这对医疗保健提供者的法律影响是广泛的，从个人责任到仇恨言论和危害人类罪。COVID-19 指南和基于评分的分诊协议必须紧急修订，以消除南非对受法律保护的患者群体（包括残疾人和老年人）的非法歧视。这将确保医疗保健从业者享有法律确定性，并确保法律的充分保护，这些弱势群体和高龄人群在宪法上有权享有这些保护。
