COMMENTARY

COVID-19 and Healthcare Rationing: A Disabled Doc's View

Dinesh B. Palipana, MD, LLB, OAM

Disclosures

May 21, 2020

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While studying to be a lawyer, I found myself battling against depression, a panic disorder, and agoraphobia. As it turns out, that was one of the best things that has ever happened to me. My doctor found that I was profoundly anemic and eventually diagnosed me with celiac disease, which may have contributed to my symptoms. Managing that condition and addressing my mental health changed everything for me, including my career. That experience made me realize I wanted to become a doctor.

Then, about halfway through medical school, I was in a car accident and was left paralyzed.

In January 2010, I was driving back from visiting my parents when I lost control of my car on a rain-slicked road. My car rolled nose-to-tail and landed on the roadside. When I tried to get out, I realized I couldn't move or feel most of my body. I was covered in blood from a head laceration. My sternum was dislocated. I was completely paralyzed from the chest down. When I was laying in the intensive care unit, my friend jokingly referred to me as "just a head."

I spent 8 months in the hospital and 4 more years rehabilitating before finally returning to medical school. That was when I personally learned about the social constructs that surround disability. That is, I finally understood the challenges that come from the attitudes and beliefs that others have about the disabled. Among those limiting views is whether disabled individuals "deserve" access to certain healthcare.

We've long known that healthcare rationing disproportionately affects people with disabilities. Although that disparity is often quietly swept under the rug, COVID-19 has put a spotlight on the subject. As one of my bosses recently said, "These are politically unpleasant issues, but we, as a society, need to talk about them." As a doctor with disabilities, here are my thoughts.

Going Beyond Guidelines

Difficult questions about disability are nothing new for me. When I returned to medical school, my abilities were often doubted. "Can you even type?" a radiologist asked. "Would patients take you seriously?" a pediatrician inquired. "Would you want him treating your family?" a senior academic asked one of my lecturers. Initially, I was deeply hurt by all of this. To be criticized for your physical being can be demoralizing. Ultimately, I remembered that I am the only person accountable for how I live. Not them. Instead of giving up, I kept working toward my dream.

When I graduated and was registered to practice, the employing state health organization was reluctant to give me an otherwise guaranteed internship. Eventually they did, and in 2018, I was awarded Junior Doctor of the Year at our hospital. Shortly thereafter, I became senior resident in the busiest Australian emergency department. What really gave meaning to all the challenges I overcame was when a patient with a significant disability told me, "I'm so glad that you came into this room as my doctor, because I knew that you would understand." Everything was beginning to fall into place.

Then COVID-19 hit.

As the pandemic began, concerns about persons with underlying conditions and disabilities emerged. We realized that there are swathes of vulnerable populations who identify with disabilities and have compromised physiologies. Society grappled with questions about how ventilators can be rationed between people with disabilities and those without.

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