Your Opinion Requested: In a National Disaster, Should People with Disabilities Be Treated Equally?

It's a national disaster. Buildings are burning - or an epidemic is raging. Medical and food supplies are dwindling. Patients are lined up at the doors of the hospital. One is 85, with dementia. One is a 35 year old mother. Who gets treated? The answer seems obvious: the younger person with responsibilities of her own should surely get priority, right?

Take it a step further. The two patients are both 35. They're both mothers. One has advanced cancer. The other is healthy. Who gets treated? Even in this case, the answer may be relatively obvious.

What if they're both 35. Both healthy. Neither have children. One has a mental illness. The other doesn't. Not so easy now, perhaps? What if they're both children - and one has autism?

Shannon Johnson, the creator of the Foggy Rock online autism community pointed me in the direction of an article on CNN.com which outlines who should get treatment in the event of a pandemic or national disaster. Here's the gist:

To prepare, hospitals should designate a triage team with the Godlike task of deciding who will and who won't get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:

• People older than 85.
• Those with severe trauma, which could include critical injuries from car crashes and shootings.
• Severely burned patients older than 60.
• Those with severe mental impairment, which could include advanced Alzheimer's disease.
• Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

Dr. Kevin Yeskey, director of the preparedness and emergency operations office at the Department of Health and Human Services, was on the task force. He said the report would be among many the agency reviews as part of preparedness efforts.

Public health law expert Lawrence Gostin of Georgetown University called the report an important initiative but also "a political minefield and a legal minefield."

The recommendations would probably violate federal laws against age discrimination and disability discrimination, said Gostin, who was not on the task force.

If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said. While health care rationing will be necessary in a mass disaster, "there are some real ethical concerns here."

James Bentley, a senior vice president at American Hospital Association, said the report will give guidance to hospitals in shaping their own preparedness plans even if they don't follow all the suggestions.

Shannon, reading this article, asks:

As a mother, thinking that my impaired child with autism would be denied treatment because of his disability is just appalling. I understand the need for public health discussions, but am still left feeling like I just been hit with a fist in the gut.....What percentage of our population would this affect? How many are children? What happens to those not treated or allowed medical care? Where do they go? Are they then banned from school and public places?......Are they quarantined away from others? Will families be forced to choose between caring for their disabled child, or seeking treatment for their other children or family members? I could be over-reacting, but I think a discussion regarding the value of the disabled to society is long overdue.

So I'm inviting you to join in this discussion. In the best of all worlds, every individual is supported and valued - regardless of age, ability, intelligence or other defining characteristic. But in the worst of all worlds, when basic medical treatment, food, and shelter are limited - is it ethical to exclude the old, sick or disabled in order to provide for the young, well, and able? Where do you stand on this complex issue?