“This is a very important lesson. You must never confuse faith that you will prevail in the end—which you can never afford to lose—with the discipline to confront the most brutal facts of your current reality, whatever they might be.”
So said Admiral James Stockdale when interviewed by Jim Collins, author of the bestseller “Good to Great”. It was a lesson he learned while a prisoner of war during the Vietnam War for eight years during which he was tortured over 20 times. (Seriously, click the link to read about this hero).
Collins asked Adm. Stockdale who didn’t make it out from the camps. The Admiral succinctly replied: “Oh, that’s easy,” he said. “The optimists.” He explained, the optimists thought rescue was just a day away, and when the rescue did not happen, day after day, it crushed them. Instead, it was the lesson that Collins has since termed the “Stockdale Paradox” that is needed to make it through challenging times: don’t lose faith you will ultimately prevail, but deal with the harsh reality as it is.
The Stockdale Paradox is needed in the times of the COVID-19 pandemic, particularly with what current best estimates tell us and some state protocols that disability advocates are pushing back against.
Not peaking in hospitalizations until May
While there was some talk during week two of the Great Shutdown that perhaps things would stabilize enough to begin opening businesses around Easter, that is not what the current best estimates suggest.
The people at 538–you know, the writers who have a pretty impressive track record of predicting the winners in elections–have turned their number-crunching eyes to the COVID-19 spread. What they find is discouraging.
This post collects and analyzes the estimates from various experts to then come up with a “best estimate.” Here is the range of estimates for the total deaths to be attributed to COVID-19 in the United States:
From this range, 538 gives as its best estimate that we can expect 246,000 deaths from COVID-19 in 2020. Let that sink in for a moment: almost a quarter of a million people.
With this expected increase in the number of cases, here is what they think is the probability of hospitalizations peaking over the coming months:
If this is correct, we will look back on March 2020 as “the good times” relatively speaking. This means we will have months of increasing cases and hospitalizations.
And, lest you think the folks at 538 are overly pessimistic, or even trying to start a panic, consider this: they project 117,000 cases reported on March 29, 2020. The screen grab at the top of the map from the New York Times puts the total cases at 93,000 as of March 27, 2020. If anything, 538’s estimate may be low.
Complaints to prevent discriminatory rationing
Given this harsh reality that the Stockdale Paradox tells us we must deal with, what does this mean for our loved ones with disabilities?
It means the U.S. health system, which has been shown to barely have enough supplies to handle what will be the relatively low numbers, will very likely get to the point of being overly-saturated with patients in need of care. That will be when the choices are going to start being made of who gets an ICU bed, who gets a ventilator, who gets treatment, and who doesn’t.
Disability rights advocates in Washington and Alabama have filed complaints with the Department of Health & Human Services’ Office of Civil Rights. They are seeking federal intervention to stop their respective states’ protocols from discriminating against individuals with disabilities when it comes to rationing decisions for healthcare.
In Washington, the key phrase that is the focus of concern is the state guidance that rationing decisions should be made based on the following:
The Alabama complaint concerns an existing state protocol for mass casualty rationing that is expected to apply to the COVID-19 pandemic, which specifically addresses ventilators and those with “mental retardation”:
Both complaints detail the historical discrimination against individuals with disabilities, particularly the negative view held by the medical profession of those with cognitive disabilities. With that historical context, the complaints raise concerns over the arbitrariness of relying on individual practitioners and their biases to determine what constitutes “severe mental retardation” or “baseline functional status [of] cognition” when determining who gets an ICU bed or a ventilator.
The Stockdale Paradox Applied
As covered in my first post on the pandemic, this is the cold, harsh reality we must now deal with. Not only is it likely that individuals with Down syndrome and other cognitive disabilities will be discriminated against, those discriminating will be following official policy.
The Stockdale Paradox emphasizes we cannot lose faith that ultimately we will prevail over the current challenges, but it also emphasizes having to deal with the reality you’re living in. So, we cannot just hope things will improve. First, it does not look like that will happen for several months, and, second, simply hoping renders you one of the “optimists” who Adm. Stockdale said did not make it out.
Instead, consider working with your local support organization and local disability rights organizations to determine what your state’s protocols are for rationing in times of emergencies. If you find provisions that are concerning like those from Washington and Alabama, well advocates in those states have provided a template with their complaints for you to follow.
On a micro-level, let’s each of us support one another by helping us get through the social distancing that is needed to prevent exposing our loved ones who may be more susceptible to COVID-19’s effects. Because if they do get infected as the number of cases grow, they may be discriminated against for their functional level of cognition.
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