Oregon's Denial Disabilities and Quality of Life

Abstract

Rationing that considers quality of life must be allowed to go\nforward even if at times it happens to disadvantage some persons with\ndisabilities. Indeed, it is questionable whether we could ever devise a\nsystem of priority-setting that was not informed in some measure by\nassessments of quality of life. Disadvantage, however, is not the same thing\nas the invidious discrimination the ADA [Americans with Disabilities Act 1990]\nseeks to preclude. We can live with some outcomes disadvantageous to some\npersons with disabilities -- so long as quality of life measures adequately\ntake into account the judgments of those who experience disabling conditions\nat first hand, and so long as any such disadvantages are significantly driven\nby medical outcomes data and not disability per se. Nevertheless, the flags\nthat the Department of Health and Human Services saw in the Oregon plan for\nreforming Medicaid and eventually more of its health care system were real\ndanger flags. Properly qualified and interpreted, the questions about\nconsistency with the ADA that the department has asked raise important\nfundamental issues about the fairness of different methods of measuring\nquality of life for use in allocating health services. It is disturbing to see\nacross-the-board opponents of any and all rationing apparently get some of the\nadministration's ear, and it must have been terribly maddening for Oregon\nofficials not to have been consulted earlier about the department's potential\nobjections, but the administration has reinserted an appropriate consideration\nof the disadvantaged individual back into what might have become Oregon's too\nnarrow reflection of dominantly "communal" values.