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Written Observations to Minister for Health Set Out Recommendations

 The Irish Human Rights and Equality Commission has recommended a review of the Department of Health’s guidance framework on prioritisation in access to critical care in the context of COVID-19. The Commission made this recommendation in a written submission to the Minister for Health, to ensure this important guidance meets the highest standards of human rights and equality compliance, particularly in relation to those groups potentially most impacted. In its observations submitted to the Minister and published today, the Commission sets out its concerns that the current guidance is ambiguous about how age and disability, for example, are to be treated in a critical care triage process, in the event that demand for critical care exceeds availability. The Commission has considered the guidance on prioritisation in access to critical care set out in the Department of Health’s recently published documents, namely the:
  • ‘Ethical Framework for Decision Making in a Pandemic’ published on 27 March (the Framework)
  • ‘Ethical considerations relating to critical care in the context of COVID-19’ published on 3 April (the Considerations);
  • ‘Ethical considerations relating to critical care in the context of COVID-19 – Supplementary Information’ published on 1 May (the Supplementary Information).
While recognising that these documents were developed at a moment of acute crisis, when it was difficult to predict if the COVID-19 virus could be suppressed and contained, the Commission recommends that the issues raised are too profound not to be open to further consideration and public scrutiny. The Commission specifically notes in relation to the existing framework that it:
  • Does not specifically consider relevant domestic or international equality and human rights law and standards
  • Does not discuss legal and human rights requirements which clinicians need to follow in making decisions about patients
  • Reflects limited or no consultation with those groups most likely to be affected
The Commission strongly recommends that a participative consultation process be initiated as soon as possible to further refine the framework documents produced to date. Such a consultation should include relevant rights-holders and/or their representatives, and draw on human rights and equality expertise.  The Commission specifically notes that the Ethical Framework itself argues that the procedural value of ‘inclusiveness’ requires that “stakeholders are consulted (to the greatest extent possible in the circumstances), views are taken into account, and any disproportionate impact on particular groups is considered” (p.9) Speaking today, Acting Chief Commissioner Dr. Frank Conaty stated:
“The choices we make in a crisis have far-reaching implications for our society in the aftermath.  Therefore it is more important than ever that we adhere to clear human rights and equality values in our deliberations and decision-making.” “Consultation in the preparation of these guidance documents was very limited at best and did not engage with those people most likely to be particularly affected. This crucial omission now needs to be rectified.” “As a Commission we know that there are no easy answers to the questions posed by a need to prioritise access to critical care.  However, as a society, we can protect and uphold our values by explicitly considering such fundamental decisions through the prism of human rights and the equal dignity of each person.”
ENDS/ For further information, please contact: Brian Dawson, IHREC Communications Manager, 01 8589601 / (087) 0697095 bdawson@ihrec.ie Follow us on twitter @_IHREC

Editor’s Note:

The full text of the Commission’s submission to the Minister for Health and the cover letter which accompanied the submission is available at the following link: The Commission’s letter of March 25th to An Taoiseach Leo Varadkar T.D. in recognition of the unprecedented public health emergency caused by the COVID-19 pandemic  is available at the following link: IHREC Letter to An Taoiseach March 2020

Irish Human Rights and Equality Commission

The Irish Human Rights and Equality Commission is an independent public body, appointed by the President and directly accountable to the Oireachtas. The Commission has a statutory remit set out under the Irish Human Rights and Equality Commission Act (2014) to protect and promote human rights and equality in Ireland, and build a culture of respect for human rights, equality and intercultural understanding in the State. The Irish Human Rights and Equality Commission is Ireland’s national human rights institution and is recognised as such by the United Nations. The Commission is also Ireland’s national equality body for the purpose of a range of EU anti-discrimination measures.