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Bangladesh Journal of Bioethics 2021; 12 (1): 54-60 

 

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Why A New Ethical Framework Is Needed To Eliminate Disability 

Discrimination? A New Learning From The Pandemic. 

 
Gausul Azam Ranju1 and Tania Serice2 

 
1. Physiotherapist & In-charge, Physiotherapy Department, BGC Trust Medical College & Hospital 

(BGCTMCH), Chittagong, Bangladesh and Founder of Ethics Policy & Inclusion (EPnI), Rowsonhat, Nasir 

Building, Chittagong, Bangladesh. Email: physioranju@gmail.com. ORCID: https://orcid.org/0000-0002-6261-

8557 (Corresponding author). 

2. Senior Staff Nurse, Ministry of Health and Family Welfare, Bangladesh. 

 

DOI: https://doi.org/10.3329/bioethics.v12i1.51902  

 

Abstract: Discrimination between disabled and non-disabled people is still an issue of fairness and 

justice. In this COVID-19 pandemic time, this issue highlighted in a significant way. In hospital, the 

disabled persons to face today issues while triage like whether they have the right to get the ventilator 

first when there is limited ventilation support or their vulnerability could be the cause for being neglect 

or they do not have to have a quality of life. There are lots of ethical dilemmas that we face today and 

these are not solvable overnight by the existing framework or policies. The existing paternalism, 

utilitarianism, or even ableism can not ensure making people living with disabilities (PLWD) rights 

equal. It is very clear that the professional expertise, policy or framework have so many loop holes that 

we are still struggling to take steps to effective and ethical decision making. This paper focuses the 

emergency of ethics based research, policy directions, and frameworks to eliminate those 

discriminations.  

 

Keywords: Disability Ethics, Pandemic Ethics, COVID-19, Healthcare Policy, People Living with 

Disabilities (PLWD), Disability Discrimination. 

 

Introduction: The World Bank reported 

that one billion (15% of the world's 

population), experience some form of 

disability where 110 million to 190 million 

people experience significant Disabilities1. 

If we think there are two categories of 

people on this earth - disabled and non-

disabled, do we wrong to categories human 

beings? Or, if we think that how could we 

decide “who’s life is worth living” among 

them, do we wrong? We will see some real-

life examples of those circumstances in this 

paper below. If we start our practice 

depending on these answers how could we 

maintain all the healthcare principles &  

 

 

ethics like autonomy, nonmaleficence, 

beneficence, and justice? 

The 3 ethical duties in this corona crisis for 

the healthcare leaders, proposed by the 

eminent bioethics institute Hasting Center, 

are - i) the duty to safeguard; iii) the duty to 

plan and iii) the duty to guide2. When we 

have a lot of problems and dilemmas on our 

existing ethical frameworks and policies, 

then how could we maintain our duties to 

manage the principles? If we skip to give 

the concern on that point and treat the 

disabled as normal people, then it creates 

unfairness. Because a normal person can 

use the stairs, but the wheelchair-needed 

disable person can’t. On the other hand, if 



 

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we think they are different from the able-

bodied people, then equality, equity & 

rights are questioned. This issue also 

creates a false binary to think about which 

one is normal and which one is abnormal2. 

On the other hand when a senior disabled 

patient and a junior disabled patient come 

at the same time for the same treatment, 

who should get the priority? The issue of 

ableism (discrimination in favor of able-

bodied people) and ageism (discrimination 

on the basis of age) creates a conflict on 

these points termed as structural 

discrimination2. 

 

If we are so strict to follow the duties and 

legislature that we have the concept of 

utilitarianism and deontology raises a 

myriad of ethical dilemmas which again 

make questions on the basic moral 

principles. If the policies and frameworks 

only considered the able-bodied then it is to 

deny the statement of the 2030 Agenda for 

Sustainable Development, where it is 

clearly stated that the “disability cannot be 

a reason or criteria for lack of access to 

development, programming and realization 

of human rights”1.  

 

Besides this utility and duty-based ethics 

(utilitarianism & deontology), there is 

another issue about medical paternalism 

that could hamper the doctor-patient 

relationship. Instead of getting the solution, 

it is defined as a problem indeed. According 

to the Encyclopedia of Applied Ethics 

(2012) “Paternalism is a problem, however, 

when interference with clients goes beyond 

what is absolutely necessary or is used as 

camouflage for actions that are motivated 

by other interests”3.  

 

Today, It is very clear that the professional 

expertise, policy, or framework have so 

many loopholes that we are still struggling 

to take steps to effective and ethical 

decision making. This paper focuses on the 

emergency of ethics based research, policy 

directions, and frameworks to eliminate 

these discriminations. Our aim is to 

understand why we need to develop our 

existing ethical framework and 

infrastructure and focus on the emergency 

of ethics based research, policy directions, 

and frameworks to eliminate these 

disparities. 

 

Methodology: This is a current 

controversy or short communication-based 

paper related to the COVID-19 pandemic 

crisis. It is not a biostatistical based study 

but an ethical based case study and  

investigation. It does not collect any data 

from the patients or any other respondents, 

and that's why informed consent is not 

necessarily important for this account. In 

this article, two patients' names are 

mentioned directlly as “Michael Hickson” 

and “22-year-old Ginny” in the case section 

number [2] and [4] below, where their 

info’s we just collected from the authentic 

press/media reports that we already cited in 

our article. We did not use any scale but we 

make arguments based on the very 

established bioethical theories like - 

utilitarianism, paternalism, and ableism. To 

make the citations & bibliography we use 

Mendeley software.  

 

Ethical Dilemmas: 

[Case 1]: COVID-19 pandemic raises a 

myriad of ethical dilemmas. Among these 

dilemmas, Bramble 2020 mentioned 8 

major ethical questions - (1) question on 

lockdown, (2) who is morally blame to 



 

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COVID-19, (3) question about immunity 

passport, (4) Question on mask, (5) 

question on moral duties, (6) question on 

vaccine trial, (7) triage question & (8) 

question on living the life4. From these 

important questions, number seven (7) is 

very relevant to think about the rights and 

facilities for pandemic healthcare. He asked 

if all of the life-saving resources (e.g - 

ventilator, ICU bed, etc) of the hospital 

have to run out, who should get their first 

use? If it could be the issue of disability 

then this problem faces a major challenge 

to eliminate discrimination. Now it is clear 

that this triage problem increases the 

disability discrimination instead of 

elimination and even if the solution is asked 

to the bioethicist - how would we be 

satisfied in this disability triage critics, they 

have no easy answer yet5. 

 

[Case 2]: Michael Hickson, a quadriplegic 

patient tested positive for COVID-19 in 

early June in Austin, Texas. He was 

admitted to the St. David’s South Austin 

Medical Center from a nursing home. 

Eventually, the hospital stopped treating 

him. Cause? The doctor said the man has no 

“quality of life”. A recorded conversation 

explains that - Doctor asked “will it 

(treatment) affect his quality, will it 

(treatment) improve his quality of life? And 

the answer is no”. The patient already died. 

The patient’s wife asked - Does it mean that 

he’s paralyzed with a brain injury, so he 

doesn’t have the quality of life? The doctor 

said - “Correct”6.So, there is another ethical 

question on that perspective and that is - If 

someone is disabled (paralyzed), does it 

mean that - he does not have a quality of 

life?  

 

[Case 3]: In Nepal, A wheelchair user 

disable was died after he was suspected as 

COVID positive in the southern Chitwan 

district. When he was admitted into a local 

hospital, there were no wheelchair-friendly 

healthcare facilities which may cause his 

death as stated by the German public 

international broadcaster Deutsche Welle7. 

The lack of adequate facilities makes them 

vulnerable and if it is, then could we say 

that this vulnerability is intentionally man-

made?  

 

[Case 4]: As stated by the BBC, 22-year-old 

Ginny was a wheelchair needed girl who 

needed a supporter or assistant to conduct 

her daily life. If her assistant became 

COVID positive in any case, it would be a 

very complicated situation for her. She had 

a ventilated tracheotomy and she was very 

anxious due to the lockdown for “zero 

guidance” if her assistant became ill or 

isolated. As a people living with disability 

(PLWD), Ginny has 11 times more likely to 

die than her peers due to this COVID 

pandemic8. What should we do to eliminate 

this discrimination here? 

 

[Case 5]: Study says people with 

intellectual and developmental disabilities 

(IDD) has a high risk of sever outcomes 

from COVID-199. According to FAIR 

Health study, people with intellectual 

disabilities and developmental disorders are 

3 times more likely to die if they have 

COVID-19, compared with others. It does 

not end, people with related conditions like 

down syndrome and other chromosomal 

anomalies and congenital conditions like 

microcephaly have also the risk. Director of 

medical ethics at the New York University 

Grossman School of Medicine, Arthur 

Caplan commented “There is no 



 

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question….These people are high risk and 

must be given priority for vaccination”10. 

But Who here? And Who cares? When, We 

have a gap into our guidelines and policy 

making for immunization11. This is the 

point to raise the question - how could we 

distribute vaccines for the greatest good for 

the greatest number?  

Argumentation: There are more than 1 

billion disabled people in the world. In only 

the UK two-third of COVID, deaths have 

occurred within the disabled community, 

stated by the BBC8. Now it is very common 

and we all know by heart that washing 

hands frequently and maintaining 6 feet of 

physical distance prevents SARS-CoV-2 

contamination, but is it disable friendly? 

Hand washing and physical distancing are 

not always possible or sometimes 

impossible for the peoples living with 

disabilities12. When we need to take 

immediate response for an immediate 

situation we are not ready to create disable 

friendly policy and infrastructure compared 

to the non-disabled. We may notice now, in 

the civilized world people living with 

disability (PLWD) are faced with a lot of 

discrimination like the upper [1], [2], [3], 

[4] and [5] cases.  

 

When a pandemic has a great risk and it is 

more dangerous, the inequalities in the 

healthcare sector acts as a mediator to 

enhance public health discrimination. 

People living with disabilities (PLWD) 

faced discrimination and some of them also 

faced unfairness by medical 

professionals13. To achieve universal health 

coverage when it is important to maintain 

global health commitment, 80% of people 

living with disabilities (PLWD) from the 

low-income and middle-income countries 

faced a limited capacity to respond with the 

COVID-19. And in this way, the risk of 

increased mobility and mortality is growing 

up. In a recently published paper in the 

Lancet Public Health, Richard Armitage 

from University of Nottingham stated that 

three issues make PLWD more vulnerable: 

(1) inequities to access public health 

messaging, (2) disruption of the physical 

distancing, and self-isolation, and (3) 

increasing risk of COVID-19, and the 

additional barrier to get healthcare 

facilities14. 

 

The debate also have raised a few dilemmas 

between people with chronic conditions 

and disabilities. A burning question about 

the triage process is who particularly will 

be treated as more vulnerable to get 

emergency healthcare (e.g. ventilator) first 

and and why. COVID-19 pandemic has 

now untold suffering among all aspects of 

human lives. Disabled people are 42% 

more likely to have poor health and, 

therefore, they are extremely vulnerable to 

the virus. According to the WHO, people 

with disabilities have a high risk due to their 

difficulty to enter the hospital or clinics, 

difficulty to maintain social distance, 

problem to gather updated information, and 

for the problem to touch anything15. Hence, 

it is difficult and sensitive to measure who 

will get the healthcare first. 

 

According to the Equality Act 2010, it is 

unfair to create discrimination with the 

people living with disabilities (PLWD)16. 

Though the disability rights movement, the 

disability discrimination legislation, and 

the UN convention on the rights of persons 

with disabilities change the perception of 

the disability, there is another perception 

between the difference of disability rights 

and human rights. And now the healthcare 



 

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priority is seemingly an issue about rights. 

According to the UN convention, the 

disability right is not so specific an issue or 

different than the human right. They all are 

the citizens and have a similar right as 

human rights e.g- rehabilitation, healthcare, 

live into the community, and the right to 

have a say about their own healthcare 

facilities. Like every human being, people 

living with disabilities also need the same 

healthcare and treatments17. So when the 

disability comes in front, why this question 

arises - who will get the healthcare (e.g 

ventilator) first? To eliminate these 

disparities the concept of the “medical 

model” or later the “social model” 

legitimate medical paternalism17. But is it 

suitable to make this answer ethical?  

 

On the other hand, for the fair distribution 

of all facilities, there are still several 

dilemmas to decide what we should do in 

terms of best interest of the patient, scarce 

hospital resources and most perceived 

benefit of the society. Based on the 40 years 

of philosophical and academic observations 

by the scholars in the field of disability, 

Reynolds stated that the 3 core insights 

from disability theory: “assumptions about 

the quality of life, the problem of ableism, 

and the distinction between disability, 

disease, and illness”18. When medical 

rationing and disability justice is an 

essential element, ableism is one of the 

major causes of discrimination, unfair 

costing, and affect to determine the good 

health of people with disabilities today19. 

“This form of systemic oppression leads to 

people and society determining who is 

valuable or worthy based on people’s 

appearance and/or their ability to 

satisfactorily produce, excel and behave”. 

as stated by Talila A. Lewis20. So to make 

the proper framework, to decrease the 

devaluation of the peoples living with 

disabilities, “ableism” has a question mark 

and the question is whether it is really 

working. 

 

Thirdly among the three philosophical 

approaches (Utilitarianism, Liberalism & 

Communitarianism) utilitarianism is the 

most important public health discourse and 

a standard among the policymakers and the 

practitioners. According to Beauchamp and 

Childress Utilitarianism is one of the ethical 

theories also that help to make a final 

decision based on their ultimate ends and 

consequences and it is the best-known oft-

ed used theories for the medical and nursing 

ethics21. So, could it be confirmed to 

eliminate the discrimination of the public 

health issues of the disabilities?  

 

All of these models or frameworks have 

proved their effectiveness in different 

settings and context; however, the issue of 

argument is based on the fact that still 

discrimination is happening in situ. Medical 

paternalism is like a tendency of a 

physician that determines patients' wishes 

or choices should not be honored. So it 

makes a patient surrogate-decision-maker 

and disvalues their autonomy22. However, 

according to Bassford, “ … … medical 

paternalism is only considered when 

utilitarian considerations apply and don't 

violate any personal rights”23. 

Unfortunately, Roger Severino, the director 

of the Office for Civil Rights at the U.S. 

Department of Health and Human Services 

warned that “ … … Medical providers must 

not engage in “ruthless utilitarianism” in 

deciding who gets life-saving treatment for 

the coronavirus”24. He claimed by the name 

of utilitarianism, disables and old people 



 

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should not be put at the end of the line for 

healthcare facilities in this pandemic 

emergency24. Hence, if we think or judge 

paternalism or utilitarianism or anything 

other else is an appropriate medical or 

social model or framework to eliminate the 

discrimination, then how can we overcome 

from being ableism? As stated by Leah 

Smith,“Ableism is a set of beliefs or 

practices that devalue and discriminate 

against people with physical, intellectual, 

or psychiatric disabilities and often rests on 

the assumption that disabled people need to 

be ‘fixed’ in one form or the other. Ableism 

is intertwined in our culture, due to many 

limiting beliefs about what disability does 

or does not mean, how able-bodied people 

learn to treat people with disabilities and 

how we are often not included at the table 

for key decisions”25.  

 

Leah Smith says that to de-root this ableism 

it is essential to set up and fix that there is 

always a seat at the table for both of you and 

those who are not like you, and it is also 

considered to judge our treating procedure 

when a person with disabilities once seated 

at the table. Therefore, ableism raises the 

assumption that the able bodies are more 

superior than the non-able or abnormal 

bodies. Oppositely the other issue of 

injustice could occur if disabilities are over 

medicalized17. 

 

Conclusion: Though there are lots of 

frameworks are available to date, the rising 

ethical issues as discussed in this paper can 

not be solved. To eliminate the disparities, 

we recommend further ethics based 

research, policy directions, and ethical 

framework to decrease the health 

inequalities for individuals with 

disabilities, which will also help to 

strengthen health and human service,  its 

workforce capacity and ensure inclusive 

environment for people living with 

disability for future pandemic and economy 

of the country.  

 

 

References: 

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https://www.worldbank.org/en/topic/disability(Acc

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(Accessed on 13 Sep. 2020) 

 

Author contribution: 1st author Gausul Azam 

Ranju conceived the idea, designed of the 

manuscript, performed the literature search, wrote 

the initial draft, checked the manuscript 
meticulously and gave final approval of the 

manuscript for submission. 2nd author Tania Serice 

did the critical revision of the article, performed the 

literature search and gave the final approval of the 

manuscript for submission.  

 

Conflict of interests: No conflict of interest in this 

study to declare.  

 

 


