Disability Bias in Patient Prioritization: How Patients’ Mobility Impairments Influences Prioritization to Mechanical Ventilation

Background: During the COVID-19 pandemic, prioritization guidelines raised concerns that disabled patients would be de-prioritized for life-saving procedures, but empirical evidence is lacking. Objectives: To examine how physicians prioritize hypothetical patients with mobility impairments and to test the association between their attitudes toward disabled people and their prioritization preferences. Methods: Physicians and medical students completed a questionnaire comprising a vignette asking them to prioritize eight hypothetical patients needing mechanical ventilation. Each patient was described by a combination of paralysis from the waist down (yes/no), parenthood (yes/no), and employment (yes/no), reflective questions on the prioritization process, and attitudes towards people with disabilities and demographics. De-prioritization was defined as prioritizing a disabled patient lower than a similar patient without a disability. We tested the associations between attitudes towards people with disabilities, considerations taken during the prioritization process, and de-prioritization. Results: A total of 61.6% (77/125) of participants made de-prioritization decisions, with 38.4% de-prioritizing all hypothetical patients with disabilities. Negative attitudes toward patients with disabilities predicted de-prioritization (b = 0.75, SEb = 0.37, OR = 2.12, p = 0.041). Mediation analyses revealed an association between negative attitudes and considering patients’ presumed social and familial roles in the prioritization process, which was associated with de-prioritization of disabled patients (b = 0.26, SE = 0.16, 95% CI = 0.03,0.65, p < 0.001). Conclusion: This study indicates that during shortage in medical resources physicians may de-prioritize patients with lower limb paralysis without sound clinical justification. It suggests that negative attitudes towards people with disabilities predict employing non-medical considerations during prioritization, which are associated with discrimination against such patients in need of emergency interventions. We recommend enhancing physicians’ education about potential biases towards people with disabilities and implementing ethical guidelines to ensure fair prioritization of medical resources and equitable healthcare for these patients.