Health Care Standards Development Committee
Dear Chair Bell:
The Ontario Human Rights Commission (OHRC) welcomes the Health Care Standards Development Committee’s initial recommendations for developing health care accessibility standards (the recommendations) under the Accessibility for Ontarians with Disabilities Act (AODA), and applauds the diligent work of the Committee in their development.
Over the last several decades, during the OHRC’s own work with persons with disabilities and disability-rights advocates, we know that even though people are protected from discrimination and harassment under the Ontario Human Rights Code (Code) based on the ground of disability, this is often not the lived reality. People living with disabilities continue to experience significant marginalization and exclusion in many service areas, including health care.
As you know, under the Code, service providers have a legal duty to accommodate the Code-related needs of service users. Providers should make sure their services and facilities are designed inclusively, and must remove any individual and systemic barriers that may exist, unless that would cause undue hardship.
In this context, the OHRC strongly supports the Committee’s efforts to make recommendations aimed to reduce, and preferably eliminate, the variety of barriers people with disabilities face throughout their patient journey within hospitals, and when receiving health care. The OHRC agrees with the Committee’s view that accessibility standards for health care are needed throughout the health-care continuum, and any recommendations should apply to all public and private healthcare facilities.
The OHRC also recognizes the AODA Alliance’s many important recommendations in its August 3, 2021 brief to the Committee on the initial recommendations.
The OHRC is pleased to see human rights principles and obligations affirmed throughout the Committee’s recommendations. These include, but are not limited to:
- System-wide requirements that ensure the accommodation needs of persons with disabilities are identified, recorded, shared and acted on at each point of contact
- Creating an overall organizational culture of accommodation through education, including anti-ableism training, accountability and enforcement
- Respect for the capacity of persons with disabilities and the need to facilitate informed consent with accommodations in place
- Accessible processes for patients to raise concerns and make complaints without fear of reprisal
- Clear compliance, accountability and enforcement measures for service providers
- System-wide education and training for healthcare providers and administrators
- The need for accessibility in emergency or pandemic situations.
The COVID-19 pandemic has resulted in a health, social and economic crisis of unprecedented scope. Persons with disabilities have been and continue to be disproportionally affected. The OHRC strongly supports recommendation #22: accessibility and disability during a pandemic or emergency situations (set out in part below). Over the past year and a half, the OHRC has repeatedly raised concerns about various versions of Ontario’s triage protocol and we therefore recommend the following highlighted additions:
- Following the end of declarations of a state of emergency, government conduct a review of successes and failures in relation to persons with disabilities and their access to health care. This should include:
- Establishing an advisory panel to provide guidance throughout the ongoing state of emergency, and on an ongoing basis following the end of emergency orders. The advisory panel must include a majority of members with lived experience of disability as well as human rights expertise
- Conducting a broad, accessible consultation of persons with disabilities on their experiences during the state of emergency to inform future government programs and services in similar states of emergency. This should occur as soon as possible following the end of the current emergency orders.
- Government work with hospitals and other public sector partners to ensure a disability and accessibility lens is applied to management of emergency situations. This should include the following considerations:
- Ensuring that Ontario's clinical triage protocol is consistent with an accessibility and human rights lens and with current, established scientific principles of testing (for example, validity and reliability).This is achieved through urgent, ongoing and meaningful consultation on the clinical triage protocol with persons with disabilities, disability rights advocates, human rights experts and other vulnerable Code-protected groups
The OHRC recommends acknowledging the unique needs of people with mental health and addictions disabilities, or psychosocial disabilities, in the Committee’s recommendations.
People with psychosocial disabilities experience disability, impairment and societal barriers in many different and unique ways, especially while receiving healthcare services. These disabilities are often “invisible” and episodic, with people sometimes experiencing periods of wellness and periods of disability. Many people with psychosocial disabilities are unaware of their rights to accommodation, and people may be reluctant to say they have a disability and need accommodation because they fear they will face discrimination.
For more on the OHRC’s work in the area of psychosocial disabilities, see our report: Minds that Matter: Report on the consultation on human rights, mental health and addictions.
The OHRC looks forward to the Health Care Standards Development Committee’s final recommendations and Government response. Should you or your team wish to follow up with the OHRC, feel free to contact Jeff Poirier, Director (Acting), Policy, Education, Monitoring and Outreach branch, at Jeff.Poirier@ohrc.on.ca.
cc: Hon. Raymond Cho, Minister for Seniors and Accessibility
Hon. Doug Downey, Attorney General
David Lepofsky, Chair, AODA Alliance