User:NesreenShah/Ableism

This is where we will be drafting our article edits! For the "Healthcare" section on the Ableism page, there is only one sentence, so we will be adding a "Healthcare in Clinical Settings" subsection, "Healthcare in Criminal Justice Settings" subsection, and a "Healthcare Policy" subsection. Our edits are in bold.

Healthcare
Ableism is prevalent in the many different divisions of healthcare, whether that be in prison systems, the legal or policy side of healthcare, and clinical settings. The following sections will explore the ways in which ableism makes its way into these areas of focus through the inaccessibility of appropriate medical treatment.

Ableism in Clinical Settings
Just as in every other facet of life, ableism is present in clinical healthcare settings. A 2021 study of over 700 physicians in the United States found that only 56.5% "strongly agreed that they welcomed patients with disability into their practices." The same study also found that 82.4% of these physicians believed that people with a significant disability had a lower quality of life than those without disabilities. Data from the 1994–1995 National Health Interview Survey-Disability Supplement has shown that those with disabilities have lower life expectancies than those without. While this can be explained by a myriad of factors, one of these factors is the ableism experienced by those with disabilities in clinical settings. Those with disabilities may be more hesitant to seek care when needed due to barriers created by ableism such as dentist chairs that aren't accessible or offices filled with bright lights and noises that can be triggering.

In June of 2020, near the start of the COVID-19 pandemic, a 46 year-old quadriplegic in Austin, Texas named Michael Hickson was denied treatment for COVID-19, sepsis, and a urinary tract infection and died 6 days after treatment was withheld. His physician was quoted as having said that he had a "preference to treat patients who can walk and talk." The physician also had stated that due to Hickson's brain injury he didn't have much of a quality of life. Several complaints have since been filed with the Texas Office of Civil Rights and many disability advocacy groups have become involved in the case.

Several states, including Alabama, Arizona, Kansas, Pennsylvania, Tennessee, Utah, and Washington allow healthcare providers, in times of crisis, to triage based on the perceived quality of life of the patients, which tends to be perceived as lower for those with disabilities. In Alabama, healthcare providers are allowed to disclude patients with disabilities from treatment who require assistance with various daily tasks.

Healthcare in Criminal Justice Settings
The provision of effective healthcare for people with disabilities in criminal justice institutions is an important issue because the percentage of disabled people in such facilities has been shown to be larger than the percentage in the general population. A lack of prioritization on working to incorporate efficient and quality medical support into prison structures endangers the health and safety of disabled prisoners.

Limited access to medical care in prisons consists of long waiting times to meet with physicians and to consistently receive treatment, as well as the absence of harm reduction measures and updated healthcare protocols. Discriminatory medical treatment also takes place through the withholding of proper diets, medications, and assistance (equipment and interpreters), in addition to failures to adequately train prison staff. Insufficient medical accommodations can worsen prisoners’ health conditions through greater risks of depression, HIV/AIDS and Hepatitis C transmission, and unsafe drug injections.

In Canada, the utilization of prisons as psychiatric facilities can involve issues concerning inadequate access to medical support, particularly mental health counseling, and the inability of prisoners to take part in decision-making regarding their medical treatment. The usage of psychologists employed by the correctional services organization and the lack of confidentiality in therapeutic sessions also present barriers for disabled prisoners. This makes it more difficult for prisoners with disabilities to express discontentment about problems in the available healthcare since it may later complicate their release from the prison.

In the United States, although the population of older adults in the criminal justice system is growing rapidly, older prisoners’ healthcare needs are not being sufficiently met. One specific issue includes a lack of preparation for correctional officers to be able to identify geriatric disability. Regarding this under-recognition of disability, further improvement is needed in training programs to allow officers to learn when and how to provide proper healthcare intervention and treatment for older adult prisoners.

Healthcare Policy
Ableism has long been a serious concern in healthcare policy, and the COVID-19 pandemic has greatly exaggerated and highlighted the prevalence of this serious concern. Studies frequently show what a “headache” patients with disabilities are for the healthcare system. In a 2020 study, 83.6% of healthcare providers preferred patients without disabilities to those with disabilities. Aversive views about disabled patients lead to ableist and harmful healthcare policies. One such example is crisis standards of care. Though these standards have been in place before the COVID-19 pandemic, crisis standards of care have come to the forefront of ableist healthcare policy due to their timely relevance. In order to maximize space in hospitals, “states, localities, and individual hospitals… explicitly rul[ed] out treatment for people with certain ‘pre-existing conditions,’ choosing ‘healthy’ non-disabled people to live, and ‘sicker’ disabled people to die.”  This policy is especially concerning since, according to the CDC, people with disabilities are at a heightened risk for contracting COVID-19.

Another policy example that clearly demonstrates ableism is that of ventilator rationing for hospitals during the pandemic. New York State instituted explicit guidelines for the distribution of ventilators, naming specific exclusion criteria for access to the ventilators. These criteria were made on the basis of a patient’s functional status—read: presence of disabilities—and prognosis. Some examples given for functional statuses include recent cardiac arrests, hypotension, and currently needing a ventilator, inter alia. In short, such policies aim to make an objective decision, but instead make a subjective one.