Page - 350 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

VULNERABLE350 of the paid workers are women, 75 per cent of unpaid caregivers are women, two thirds of people with dementia are women and two thirds of people in nursing home are women. This is a highly gendered envi- ronment and we cannot ignore that.”59 Coupled with age and sex, social condition is, as Steven Lewis underscores, also a salient factor: “Less prosperous seniors who far outnumber those able to afford upscale alternatives are left to take their chances in the nursing home lottery.”60 Finally, a large majority of long-term care residents have physical and cognitive illnesses and impairments. The multiple failures that contributed to COVID-19 deaths and other harms in long-term care are, as Tess Sheldon and Ravi Malhotra’s chapter (Chapter D-9 in this volume) explains, manifestations of systemic discrimination based on physical and mental disability that s. 15 prohibits.61 Charter rights are not absolute. Section 1 permits, “such reason- able limits prescribed by law as can be demonstrably justified in a free and democratic society.”62 Intensive hospital care or ventilation is not the appropriate treatment in every COVID-19 case.63 Most long-term care residents have pre-existing medical conditions, and many are in their final years of life.64 In one Nova Scotia facility experiencing one of Canada’s worst COVID-19 outbreaks, only 20 of almost 500 resi- dents had not signed do-not-resuscitate orders.65 It is likely that only a small minority of residents would opt for aggressive COVID-19 hos- pital treatment, were it offered. But it is virtually certain that no one would have chosen to be needlessly exposed to the virus, to receive little or no palliative or comfort care, and to die in forced isolation, leaving family and loved ones to cope with anger as well as grief.66 59. Michael Brown, “How COVID-19 Overwhelmed Canada’s Long-term Care System” (22 April 2020), online: Folio <www.folio.ca/how-covid-19-over- whelmed-canadas-long-term-care-system/>; Pat Armstrong et al, Re-imagining  Long-term  Residential  Care  in  the  COVID-19  Crisis  (April 2020) at 7-8, online (pdf): Canadian  Centre  for  Policy  Alternatives <www.policyalternatives.ca/sites/default/ files/uploads/publications/National%20Office/2020/04/Reimagining%20residen- tial%20care%20COVID%20crisis.pdf>. 60. Lewis, supra note 18; Canadian Health Coalition, supra note 19; National Union of Public  and  General  Employees, supra note 19. 61. Tess Sheldon & Ravi Malhotra, this volume, Chapter D-9. 62. Colleen M Flood, Bryan Thomas and Kumanan Wilson, this volume, Chapter C-1. 63. Amina Zafar, “What Is a Ventilator and Who Gets One If COVID-19 Turns Catastrophic in Canada?” CBC News (31 March 2020), online: <www.cbc.ca/ news/health/covid19-ventilators-1.5515550>; Payne & Duffy, supra note 25. 64. Canadian Institute for Health Information, supra note 15. 65. Rankin, supra note 28. 66. Grant & Ha, supra note 5; Reith, supra note 25; Payne & Duffy, supra note 25.