SARS-COVID-19 Pandemic and Persons with Disabilities in Italy and Europe﻿

Giampiero GRIFFO, Luisa BORGIAINVITED PAPER (SPECIAL REPORT)

SARS-COVID-19 Pandemic andPersons with Disabilities in Italy and Europe
Giampiero GRIFFO,1 Luisa BORGIA 2
Griffo: Suor Orsola Benincasa University of Naples (Italy)
Borgia: Polytechnic University of Marche, Ancona (Italy)
Email: luiborgia@gmail.com (Correspondence: Luisa Borgia); giambatman1@gmail.com

1. General situation
The spread of COVID-19, as the WHO General
Director Tedros Adhanom Ghebreyesus said, has
now reached the level of pandemic – defined as“an epidemic occurring over a very wide area,crossing international boundaries and usuallyaffecting a large number of people”3 - as the most
disturbing epidemic since the Second World War.
Currently, the WHO reports over 88,828,387
persons infected and more than 1,926,625 deaths,
with Europe recording 28,794,000 infections
with 626,726 deaths (updated January 1st, 2021)4.
Government interventions, which are getting
progressively more drastic but necessary, haveupset and curtailed the most common lifestyle
habits such as having a coffee at a café or bar,having a friendly chat with the barber, going
shopping, or going out with friends. In all this,where people have their freedom restricted, what
is happening to persons with disabilities?

2. Persons with disabilities andhumanitarian emergencies
T he issue of persons with disabilities, inemergency and humanitarian interventions, hasonly recently entered international debates. It was
prompted by the case of the refugee camps in
Kosovo during the war in former Yugoslavia, reproposed (in dramatic terms) with the tsunami inIndonesia (where the treatment of persons withdisabilities often violated human rights). Also,
in Haiti, during the 2010 earthquake, as manyas 4,000 people were amputated, only because
there werenot enough health units, and so thosepeople did not have adequate support, not only inthe provisions of prosthesis and orthoses, but alsowith regard to adequate and proper psycho-social
support for them to rebuild their lives, after thesesudden and drastic changes5.
The debate on the subject of rights for
persons with disabilities received the approvalof the Convention on the Rights of Persons with
Disabilities (CRPD, 2006)6, and many resolutions
guaranteeing that all persons with all types of
disabilities must be afforded all human rights
and fundamental freedoms, were adopted. It was
ratified by 182 countries (94.6% of the member
countries of the United Nations) and has now
become an international standard to be respected,
not only in legal terms but also in cultural andtechnical terms.
Indeed, CRPD, which is based on a rightscentered approach, highlights the sufferingof persons with disabilities in a society thathas created barriers and obstacles (by social
exclusions, discrimination and lack of equal
opportunities) to inhibit their self-development
and involvement in life/work activities, as they
are too often victims of human rights violations.
The convention highlights that “disability
results from the interaction between persons with
impairments and attitudinal and environmental
barriers that hinders their full and effective
participation in society on an equal basis withothers” (Preamble, letter e): this definition
revolutionizes the traditional vision, basedon a medical model of disability, assigning
responsibility for a condition of disability tostates and society, through a social model ofdisability based on respect for human rights.
The set of organizations and services of society
creates barriers, obstacles, and discrimination,and it is the responsibility of society itself andof states to reduce the causes of disability.
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Journal of Philosophy and Ethics in Health Care and Medicine, No. 14, December 2020

This enhanced sense of responsibility is all themore applicable in the field of humanitarianand emergency interventions. In fact, article
11 (S it u a t ion s of r i s k a n d h u m a nita r ia nemergencies) states: “States Parties7 shall take,in accordance with their obligations underinternational law, including international
humanitarian law and international humanrights law, all necessary measures to ensure theprotection and safety of persons with disabilities
in situations of risk, including situations ofarmed conflict, humanitarian emergencies andthe occurrence of natural disasters”. The CRPD
approach therefore recognizes the following:
persons with disabilities must enjoy all humanrights in conditions of equality with othercitizens; the condition of persons with specificcharacteristics depends on evolving bio-psychosocial factors that can be modified in the social
and individual spheres; the removal or reductionof the causes of disability is a responsibility ofstates and society; the condition of disability is
reduced or removed by attending to health, social,and human factors; the condition of disability,
being a part of life everywhere, concerns allpolicies and requires giving matters of disability
adequate attention, benefiting the whole ofsociety. These elements, applied to emergency
conditions, require reformulation of policies aswell as technical and professional interventions in
the field of humanitarian aid.
The international debate in recent years
has deepened concerning specifically the themeof the protection and safety of persons withdisabilities, by guaranteeing this group equal
opportunities and nondiscrimination. The Verona
Charter (2007) 8 began to define the generalprinciples underlying emergency interventions
for persons with disabilities by producing aninternationally oriented series of articles andmanuals, exploring the themes elaborated above,
relating to non-governmental organizations
and organizations of persons with disabilities9.
In 2015, the Italian Development Cooperation
published a Vademecum on Humanitarian Aidand Disability10, the first handbook of its kindcomposed on the subject by a government.
The United Nations has also issued a seriesof documents on the subject of humanitarian
aid and emergency interventions: the Sendai
Framework for Disaster Risk Reduction (2015)1134

and the Charter of Istanbul for Inclusion of
Persons with Disabilities in Humanitarian Action(2016)12 . According to the latter, in July 2019,an IASC13 task team completed the Guidelines
for Inclusion of Persons with Disabilities in
Humanitarian Activities14 , after two years ofwork, involving leading experts in the field.
T he ele me nt t h at c on ne c t s a l l t he s edocuments is to ensure that humanitarian andemergency aid is respectful of everyone’s humanrights. In fact, the humanitarian approach
was based on methods of rapid intervention
similar to those of military bodies or charitableorganizations (Army, Red Cross, etc.) prevailed.
This humanitarian approach, based on limiting
losses15 , worked well with the culture of thecharitable approach, based on the idea thatthe benef iciar ies of the i nter ventions areincapacitated and need only assistance. However,
the Triage approach 16 (involving a discrete
selection of which people should be assisted first,
second, and so forth) penalizes persons withdisabilities.
The humanitarian approach is based on a
two-stage intervention. In the first intervention,
the essential elements for the rescue and thef irst reception (food, health and a place of
hospitalization) must be guaranteed; afterward,
any “special” needs are put in place. The label“special”17 almost always translates to a separate,second-place, and invisible category.
Preventive and operational practices toreduce the risks deriving from disasters must be
based on multi-risk and multi-sectoral approaches
that are inclusive and accessible in terms of
eff iciency and effectiveness 18 . In the spiritof resilience, governments should work with
communities, particularly with women, children
and young people, persons with disabilities, theelderly, and volunteers in designing policies,
plans and standards. Along with this spirit ofresilience, governments and communities need to
anticipate problems that may arise, by activating
al l hu ma n , com mu n it y, a nd i n st it ut ional
resources in an organized and effective way toprevent risks and protect the entire population.
Fu r ther, all st rat a of societ y must be
activated and energized, with participation basedon empowerment and inclusion, on accessibility
and non-discrimination, paying special attention
to those affected disproportionately by disasters,

SARS-COVID-19 Pandemic and Persons with Disabilities in Italy and Europe ﻿especially the poorest and discriminated sectionsof the population. Gender, age, disability, andlocal cultures must be considered in all policies
and practices, where strong participation of
women and young people is promoted, andvoluntary citizenship associations are involved
and strengthened.
The Eu ropean Union and the Cou ncilof Europe also responded to the issue of the
inclusive emergency of persons with disabilities.
T he Cou ncil of Eu rope, af ter a ser ies ofconsultations with the sector players, in 2016,
defined a specific manual as a contribution fromthe EUR-OPA program19.
T he Eu ropea n Un ion ha s approved
several documents and policies on the issueof humanitarian aid and emergency, such as
the European Consensus on Humanitarian
Aid (2007) 20 , concerning attention to persons
with disabilities in international cooperation;
the Conclusions of the European Council “ondisabilit y-inclusive disaster management”(2015) 21 , prov id i ng specif ic at tent ion to
the inclusion of persons with disabilities inemergency interventions; the operational guide,The Inclusion of Persons with Disabilities
in EU-funded Humanitarian Aid Operations(2019)22, involving organizations of persons withdisabilities in emergency activities, reconcilingthei r k nowledge and resou rces usef ul for
emergency. Further, the European Union has
implemented a European Disability Strategy(2010-2020) 23 dealing with humanitarian andemergency aid activities, while taking into
account the rights and needs of persons withdisabilities.
Un for t u n at ely, wh at e me r ge d i n t he
COVID-19 pandemic is the almost complete
absence of persons with disabilities in theemergency interventions implemented in thevarious European countries.
The lack of coordination between welfare
systems 24 and emergency intervention systems
has made it difficult to identify persons withdisabilities, resulting in only partial intervention,
too often only purely or partially compensatory.

Giampiero GRIFFO, Luisa BORGIA

3. The protection of the humanrights of persons with disabilities
during the CODIV-19 pandemic
in Italy
The new emergency response to the COVID-19
pandemic has led to some negative consequences
for persons with disabilities. In fact, in many
areas of intervention and solutions, the difficulty
emerged in protecting and guaranteeing equalityof oppor tunity and non-discrimination for
persons with disabilities. We will analyze the
Italian case, one of the countries most affected by
COVID-19 (2,276,491 infected and 78,755 dead)(January 1st , 2021)25.
After fifteen days from the government
declaration of the presence of a COVID-19
epidemic, the Italian Society of Anesthesia,
Analgesia, Intensive Care and Intensive Care
(SIAARTI) launched recommendations on how
to intervene in a pandemic emergency situationin the presence of limited instrumental andlogistical resources26, given the sudden surge of
COVID-19 patients. These recommendations
started a debate among doctors, in particular,
among anesthesiologists and heads of intensive
care units. If the resources of beds and machinery
are limited, if physicians had to choose whom
to assist first, who should be “discarded”, using
triage, as a “throwaway”, a term similar to one
used by Pope Francis, to refer to disenfranchised
people 27? Young persons or elderly persons?
“ Nor mal” persons or persons with severefunctional limitations?
Given shortages in medical staff, material
resources, and logistical support, SIAARTI
recommended the probability of survival, life
expectancy, severe comorbidities, functionals t a t u s , w it h a v ie w t o “m a x i m i z i n g t h ebenefits for the greatest number of persons.”
However, the practical results of the SIAARTI
re com me nd at ion s me a nt t h at t he elde rly(probability of survival, life expectancy) andpersons with disabilities (severe comorbidities,functional status, disability) were effectively
excluded from treatment.
In the Republic of San Marino, the National
Bioethics Committee (CSB), which has given
much attention to the issues of disability byincluding provisions in all the documents it
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Journal of Philosophy and Ethics in Health Care and Medicine, No. 14, December 2020

approves, at the request of the Extraordinary
Commissioner for SARS-COV-19 emergency in
the Republic of San Marino (a request that took
into account the SIAARTI Recommendations),
on March 16 th , 2020 approved unanimously adocument (Opinion on use of invasive assisted
ventilation on patients with disabilities 28) inwhich he clarified that only the clinical situationmust be used to evaluate a patient’s condition
and access to care. In fact, citing the Universal
Declaration on Bioethics and Human Rights 29
and CRPD, the CSB Opinion recalled thatthe basic principles to be applied are those ofnon-discrimination and equal opportunities.
It therefore reported that CRPD dedicates a
specific article (art. 11) to “risk situations andhumanitarian emergencies” which obliges
State Parties to adopt “ in accordance withthe obligations deriving from internationallaw, including international humanitarian law
and international human rights standards, allnecessary measures to ensure the protection
and safety of persons with disabilities in risk
situat ions, including situat ions of ar med
conflict, humanitarian emergencies and natural
disasters”, requiring” health specialists toprovide persons with disabilities care of the same
quality as those provided to others” (art. 25).
Any other approach would violate the principles
of bioethics and respect for human rights.
T he debate im mediately moved to aninternational level, both for the attention ofinternational organizations of persons withdisabilities and for the widespread disseminationof the CSB opinion. At the start of the COVID-19
pandemic, the European Disability Forum,
an organization representing about 90 million
citizens with disabilities within the European
Un ion 30 , i m med iately def i ned a ser ies of
initiatives, requesting the positions of theEuropean authorities, organizing international
webinars, coordinating with other internationalorganizations to promote respect for the humanrights of persons with disabilities 31. Within a
few days, one after the other, the most importantinter national organizations came for ward,
including UNESCO 32 , the European Group on
Ethics in Science and New Technologies33, DHBIO34 and many national bioethics committees35.
All these institutional responses reiterate that the
only approach in a medical triage is the clinical36

one and any category-based approach (the elderly,
persons with disabilities) would constitute a
violation of human rights, on which respect
Bioethics is based on.
Unfortunately, the discriminatory approachhas been practiced in some European Countries36
and in some states of the US37 (CRPD has notbeen ratified by the US.).
The SIAARTI recommendations relating
to persons of disabilities have indeed influenced
similar responses in other European countries
as well as other parts of the world, and therecommendations have realized some, but not
all views of the CRPD relating to how disastermedicine is practiced.
Indeed, in Italy, a heated discussion has
opened on the recommendations of SIAARTI,
raised by the National Federation of Ordersof Surgeons and Dentists, who have accused
SIAARTI of violating professional codes of
ethics38.

4. The theme of the protection of
the elderly and persons withdisabilities
The pandemic in Italy reached extremely highpeaks in March and early April 2020 39. The
number of infected patients, the use of intensive
care, and the number of deaths reached dramatic
peaks, echoed later in other European countries,
highlighting the Italian healthcare system’s lackof preparedness in coping with the Covid-19
emergency. In the second half of March 2020,
an unimaginable phenomenon was highlighted:
in the long-term care residences for elderly
people and persons with disabilities, initially in
Lombardy, then in various regions of Italy, theepidemic struck a terrible number of patients. The
Italian College of Health, urged by the National
Guarantor of the Rights of Persons Detained or
Deprived of Personal Liberty, launched a sample
survey on assisted healthcare residences (RSA40
for elderly non-autonomous person) whichhighlighted a high level of inpatient death41. On
May 5th, 2020, the Italian College of Healthpublished a final report showing that out of 3,292
institutions surveyed (96% of the total), in the
online map of dementia services created by the
ISS Dementia Observatory (residential, public
and / or affiliated health and social contractSARS-COVID-19 Pandemic and Persons with Disabilities in Italy and Europe ﻿facilities, which welcome persons mainly withdementia) had answered the questionnaire. In
1,356 of these institutions (41% of the total), there
were 3,772 deaths from COVID-19 and similar
symptoms (41.2% of patients in care). The total
is most likely attributable almost entirely to
the COVID-19 virus because the autopsies andswabs were not done to the hospitalized. Of the5,292 persons hospitalized in the period underreview, 2,986 were suspected of COVID-19 andwith similar symptoms, equal to 56.4% of thetotal. The analysis of the time intervals of deaths
shows that at the beginning of the emergency,
no protective provisions had been put in place
and that the death trend only drops from 1 to
15 April 2020, while the mortality remained at
16%. In fact, considering the incubation periodsof COVID-19, calculated at 6 to 14 days 42 , thelack of the protective provisions in the longterm care facilities during the first period of thepandemic results is clear. Combining the relevant
data (lack of personal protective equipment for
77.2% of the institutions, difficulty in accessing
swabs for 52.1%, absence of personnel for 33.8%,
lack of specific training, difficulty in activatingrooms for patients in quarantine, lack of physicaldistancing between patients and operators,
lack of symptom monitoring systems, etc.)
and the average number of people hospitalized
in the institutions surveyed (74 beds, with aspectrum ranging from 6 to 667 places) thoseorganizations designed to protect people have notprotected these most vulnerable people, in caseof contagion; on the contrary, the organizations
have canceled the most vulnerable persons fromthe protection systems. If we think that in someregions, particularly Lombardy, elderly persons
with COVID-19 symptoms were hospitalized
in RSAs, it is evident that these practices havealso highlighted violations of Article 15 of the
CRPD 43. After September 2020, in Italy, thehigh number of deaths in homes for the elderlywith disabilities continues 44 and many familiesof assisted persons in residences filed criminal
charges for lack of protection of their loved
ones45.
The National Guarantor of the Rights
of Persons Detained or Deprived of Personal
Liberty46 also showed concern about forbidding
patient visits to the facilities. According to the
National Guarantor, “the access of relatives

Giampiero GRIFFO, Luisa BORGIA

and visitors to hospitals and assisted healthcare
residences (RSA), hospices, rehab facilities andresidential care facilities for the elderly and selfsufficient is limited to only the cases indicated by
the health management of the institution whichis required to take the necessary measures andprevent possible transmissions of infection (...)
while considering the appropriate restrictions inorder to prevent the spread of the pandemic, he
expresses his concern about the repercussions
that these limitations can have within theinstitutions for persons with disabilities and theelderly, if not properly monitored and controlled.
In fact, the situation exposes both guests andoperators to high stress. This entails an increased
risk of conflicting behavior, of mistreatment or ofabuse of restraint tools.” Only at the end of April,
the Italian College of Health decided to extend
the research to long-term residential facilities for
persons with disabilities, after various articles47
in newspapers showed similar restrictions onpatient visits.
The pandemic has brought out various
problems which have severely affected persons
with disabilities, both for the lack of attention totheir rights in the field of rehabilitation and social
services, in education - which have been abruptlyinterrupted for quarantines without alternative
domestic care - and for their work in public andin private companies, where the protection of
employees and workers with disabilities wascompromised by several obstacles.
A positive element of the COVID-19 period
was the attitude of prime minister Giuseppe Conte
who, while maintaining political responsibility
to the government on the issue of disability,
met several times with the FISH and FAND
federations 48 during the pandemic, includingin the meeting “States Italian Generals”. In his
communications to parliament, he reminded
listeners that this segment of the population
has also contributed to the development oflegislation on protection measures aimed at
persons with disabilities (unfortunately adopted
sometime later) and that a disability expert fromthe Economic and Social Committee was partof the commission set up by the prime ministerand coordinated by Vittorio Colao to elaborate
proposals in phase two of COVID-1949.
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5. Some research on the effects ofthe pandemic on persons withdisabilities worldwide
We still do not have an in-depth analysis of thenumber of research projects assessing the impactof the pandemic on persons with disabilities andtheir families around the world. However, it isenough to mention the statement by Dr. Hans
Henri P. Kluge, WHO regional director for
Europe 50 who stressed that in Europe “half ofcoronavirus deaths occurred in long-term care
residences.
European Commissioner for Justice Helena
Delli said that “persons with disabilities haveborne a disproportionate burden compared toother European citizens”51.
The International Disability Alliance (IDA),
the worldwide network that brings together
the most important international and regionalorganizations of persons with disabilities,
has conducted research on five continents tocollect information and data to monitor how
SARS-COVID-19 has affected the rights ofthe disabled. Various issues emerged from theinvestigation: lack of access to information andcommunications relating to COVID-19 for all
persons with disabilities; barriers in accessing
social protection measures and job protection(formal and informal, prevalent in countries
seeking development, job losses, and barriers
to the possibility of benefiting from remote
work; lack of inclusion of the topic of disability
in responses to COVID-19 by all levels ofnational and local government, with important
communication breaks between national andterritorial efforts. The report shows that most
persons with disabilities worldwide have been
negatively affected from the pandemic in one
way or another, with old or new barriers, evenin the reopening phase. Countries continue themanagement of COVID-19 as a public healthpolicy issue, while in the following period,
action should be taken to remove existing
barriers and rebuild the healthcare system in abetter way, starting with the most critical areas
for improvement, in order to implement thedevelopment objectives for a sustainable future.
Such an improved, sustainable system would
include persons with disabilities as beneficiaries
38of these improvements, in particular, access to
education, employment, urban areas, and thecollection of appropriate and disaggregateddata, in order to apply the CRPD. IDA itself
has testified with life stories of persons withdisabilities collected around the world how the
pandemic has affected the disabled52.
One of the signif icant f indings of the
global report on COVID-19 from the Disability
Rights Monitor (2020) 53, in collaboration with
IDDC54 , Disability Rights Fund 55 and Pretoria
University56 , is that persons with disabilities
were left behind, “regardless of their level ofdevelopment across both wealthy and developing
countries”.
The American Psychological Association
c ond uc t e d r e se a r ch t h at “shows p e r son swith disabilities are at risk for mental healthproblems” 57. A disabilit y-i nclusive Covid
response published by the House of Commons,in the UK, noted that the Office for National
Statistics analysis estimated disabled persons
made up 59% of all deaths involving COVID-19
from 2 March to 14 July 2020, in England andWales58. The UNICEF report on Child Disability
and Covid-19 (April 2020) stresses that “Thegreater burden faced by children living withdisabilities means that additional efforts will be
required to ensure their needs are being met whentransitioning to the different pandemic phases”59.
The research of American Association on Healthand Disability, that covers a broad spectrum of
research areas, has conducted a specific researchon Novel Coronavirus Pandemic and Access to
Health Services Among Adults with Disabilities
Project, showing where barriers, obstacles anddiscrimination intersect60.
Various articles have been published inrecent months on the topic of persons withdisabilities during the pandemic, highlighting
various critical issues: increase in the riskof poverty among persons with disabilities,
the vulnerability of persons with cognitive
disabilities (ID) as well as in the increaseof physical, mental, and social effects of thepandemic61. In Italy, the scientific journal New
Secondary Research published a special issue
on COVID-19 and persons with disabilities in
the area of ​​education, highlighting the strong
importance of inclusive education (Italy has themost inclusive education system in the world 62)

SARS-COVID-19 Pandemic and Persons with Disabilities in Italy and Europe ﻿

proposing some operational solutions63. The UN
Office of High Commissioner for Human Rights
regularly collects research data on persons withdisabilities and COVID-19 as these persons “faceeven greater inequalities in accessing healthcare
during the pandemic due to inaccessible healthinfor mation and environ ments, as well as
selective medical guidelines and protocols that
may magnify the discrimination persons withdisabilities face in healthcare provision”64. The
UN also collects various research data anddocuments on disability and COVID-1965.

6. Conclusions
Let us consider some final reflections. In timesof crisis, atavistic stigmas resurface, as well as
evaluations of those with socially undesirable
qualities and the different way they should betreated. As long as persons with disabilities are
considered invisible citizens or special, as longas they are not truly regarded as part of society
and mainstream policies do not take care ofthem, they will always be subject to the riskof having their rights limited or ignored andwill always be exposed, without justification,
to different treatments, which violates humanrights. The pandemic shows this sit uationin emergency actions, in medical triage, in
lockdown of services, in general attention torespecting the rights and dignity of persons withdisabilities. The visibility and highlighting ofcomplaints and proposals is an essential momentin the work of associations and federations, aswell as an opportunity to reflect on the policies
addressed to them. The application of the UN
Convention on the Rights of Persons with
Disabilities, ratified by Italy, in 2009, and by
182 UN member countries, requires movingfrom a view of protective welfare, which treats
persons with disabilities differently, often without
justif ication, considering them v ulnerable
and fragile and segregating them, to a view ofinclusive welfare, where they are full-f ledged
citizens able to participate and benefit on an
equal basis with other citizens, in all policies
and measures to protect them. In societies withdisabled persons with negative, stigmatizedcharacteristics (such as thoughtful persons ofhomosexual orientation, women in some Arabcountries, or people with dark skin, …), there

Giampiero GRIFFO, Luisa BORGIA

are also persons with functional limitations 66 .
The definition of disability in the CRPD is infact a heuristic tool to understand how disability
is a social creation: “Disability results from theinteraction between persons with impairments
and attitudinal and environmental barriers thathinders their full and effective participation insociety on an equal basis with others.” It is easy
to replace the characteristic “impairments” withother characteristics such as being a woman,being a migrant, belonging to religious and ethnic
groups other than those prevalent in a country,
having a homosexual orientation, etc. that insome societies create conditions of inequality.
The issue of segregating institutions andalternative solutions that violate human rights
is an important bioethical issue. The reasons
are many. A first strong reason derives from thefact that the National Guarantor of the Rights
of Persons Detained or Deprived of Personal
Liberty, an authority that intervenes to protect
human rights, has once again recommended
increasing controls to promote respect for humandignity. This increase shows that segregation ofpeople into special and separate places, apartfrom society in general, can lead to human rights
violations, to inhuman and degrading treatments,
and that societ y should take steps to f ind
alternative solutions, respectful of the quality oflife 67 and adequate enough to maintain contact
with the communities to which they belong. The
second reason is that the social stigmas that affectpersons with disabilities, and in recent years, also
older persons, are unacceptable.
Such negative conceptions are supported
by selected moral theorists and bioethicists
that consider persons with disabilities subhuman68 and expendable in the name of the goodof the majority of the population, forgettingthat all human lives experience some form of
disability. Persons with disability must benefit
equitably from the development of goods andservices for all, as well as from general policies
with appropriate support, even in emergency
situations.
These negative views of disability r un
through all professions, an issue that derives fromthe inertia of prejudices still strongly present
in populations around the world. It would beeven more terrible, if such negative views guide
doctors and health policies. However, bioethics
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Journal of Philosophy and Ethics in Health Care and Medicine, No. 14, December 2020

generally, as well as the ars medica and the law,has emerged to protect the weakest subjectsof society, because every citizen is a precious
asset for the state and every person, since “allhuman beings are born free and equal in dignity
and rights (..) without distinction of any kindsuch as race, colour, sex, language, religion,
political or other opinion, national or social
origin, property, birth or other status”. These
universal and inalienable principles enshrinedin the Universal Declaration of Human Rights(ONU, 1948) cannot be violated by bioethics
which has the obligation to promote, in its own
expressions, the right to life, freedom, andsecurity of every individual, in every situation,even in extraordinary ones such as a pandemic
emergency.
Endnotes
1 Co-Director of the Center for Governmentality
and Disability Studies (CeRC) “Robert Castel”,
University “Suor Orsola Benincasa” of Naples(https://www.unisob.na.it/ateneo/c007.htm?vr=1),
member of the Bioethics Com m it tee of the
Republic of San Marino and member of the WorldCouncil of Disabled Peoples’ International-DPI(www.dpi.org).
2 President of National Bioethics Committee of the
Republic of San Marino and member of DH-BIO,
Council of Europe, Professor of Bioethics at the
Polytechnic University of Marche, Ancona (Italy).
3 https://www.who.int/bulletin/volumes/89/7/11-088815/en/ .
4 See https://covid19.who.int/?gclid=CjwKCAiAi_D_
BRApEiwASslbJ-bQSQc7MDJK3dFIURA6LuDJ
uIqeeCVGnwFJnjTcYb5kGOGdj6geZBoCITkQA
vD_BwE .
5 See Pan American Health Organization. Healthresponse to the earthquake in Haiti, January 2010.
Lessons to be learned for the next massive suddenonset disaster. 2011.
https://www.paho.org/disasters/dmdocuments/
HealthResponseHaitiEarthq.pdf
6 https://www.un.org/development/desa/disabilities/
conve nt ion- on-t he -r ig ht s - of-p e r son s -w it hdisabilities.html
7 In the text of the CRPD, the States that have
ratified the Convention are defined as “States
Parties”.
40

8 The document comes from a European project on
emergency in relation to persons with disabilities,
and it was the first international reference on theissue. Verona Charter on the Rescue of Persons
with Disabilities in the Event of Disasters:
https://internazionali.ulss20.verona.it/docs/projects/
rdd/cartadiverona.pdf
9 See the bibliog raphy cont ained in M A ECIDevelopment Cooperation, Humanitarian Aid andDisabilities. Vademecum, Rome, 2015.
10 Ibidem.
11 https://www.unisdr.org/we/coordinate/sendaiframework
12 http://humanitariandisabilitycharter.org/
13 Interagency Standard Committee is the United
Nat ions’ mai n mechan ism for coordi nat ion
between humanitarian aid agencies. It is a single
forum involving key partners from the United
Nations and other governmental and civil society
bodies. It was established in June 1992 on the basisof resolution 46/182 of the General Assembly.
A representative of the Italian Disability andDevelopment Network participated in the draftingof the guidelines.
14 ht t ps://i nteragencyst andi ngcom m it tee.org /iasc-task-team-inclusion-persons-disabilitieshumanitarian-action/documents/iasc-guidelines
15 Limiting losses meant that certain groups ofpeople could be sacrificed (elderly, persons withchronic diseases, the seriously injured, etc.) whilesafeguarding the well-being of most other citizens.
16 The word “triage” is a French term that means“sorting, selection”: it is a system used to selectpeople injured in accidents according to increasing
urgency / emergency classes, based on the severityof the injuries reported and their clinical picture.
Persons with disabilities involved in naturaland human disasters are often not given priority
assistance, even if they have not been injured,and because they are considered persons with
impairment, they are rescued / assisted after theothers.
17 For example, the organization responsible to assist
the population in case of emergency situation does
not include accessibility equipment for persons
with disabilities (accessible bathrooms, usable
routes, location of these persons close to collective
services, provision of particular diets, etc.) andsuch actions are postponed to a later time. In
reality, inclusive planning can easily provide forthese services and equipment.

SARS-COVID-19 Pandemic and Persons with Disabilities in Italy and Europe ﻿

18 The multisectoral approach takes into accountthe various risk factors (health, social, economic,etc.), the different populations affected (men,women, types of families, the elderly, persons
with disabilities, migrants, etc.) and the different
solutions respectful of the various needs in termsof first aid, reception, reconstructions, etc.
19 Towards more disaster resilient societies: https://edoc.coe.i nt /en /envi ron ment /6824 -towardsmore-disaster-resilient-societies-the-eur-opacontribution.html .
20 htt ps://ec.europa.eu /echo/f iles/aid /countries/
factsheets/thematic/consensus_en.pdf
21 https://www.consilium.europa.eu/register/en/
content /out /?&t y p=ENT RY&i=A DV&DOC_
ID=ST-6450-2015-INIT
22 h t t p s: //e c .e u r o p a .e u /e c h o /s i t e s /e c h o - s i t e /files/2019-01_disability_inclusion_guidance_note.
pdf
23 ht t ps://eu r-lex.eu ropa.eu / legal- content / EN/
TXT/?uri=LEGISSUM%3Aem0047
24 T he welfare system li n ked to persons withdisabilities is often organized in separate and“special” places (day centers, rehabilitation centers,
long-term care institutions, ...) separated fromsociety which makes the beneficiaries of thoseservices invisible to society and to emergency
services. See: Disability rights during the pandemic
A global report on findings of the COVID-19
Disability Rights Monitor 2020, https://www.
internationaldisabilityalliance.org/covid-drm .
25 See https://opendatadpc.maps.arcgis.com/apps/
opsdashboard/index.html#/b0c68bce2cce478eaac8
2fe38d4138b1
26 h t t p : / / w w w. s i a a r t i . i t / S i t e A s s e t s / N e w s /COVID19%20 -%20documenti%20SIA A RTI/SIAARTI%20-%20Covid-19%20-%20Clinical%20
Ethics%20Reccomendations.pdf
27 In a 2013 general audience, Pope Francis madeexplicit his criticism of the ‘throwaway culture’:“We are experiencing a moment of crisis; we see
it in the environment, but above all we see it inman. The human person today is in danger; thereis the urgency of human ecology! What commands[respect] today is not human beings; it is money.
If a man dies of cold or starvation, it is not news,
but if the stock exchange falls by ten points, it is a
tragedy! So people are discarded, as if they were
waste. This “throwaway culture” tends to become
a common mentality, which infects everyone.
Human life is no longer seen as a primary value

28

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30

31

32

33

34

35
36

37

Giampiero GRIFFO, Luisa BORGIA

to be respected and protected, especially if they
are poor or disabled, if they are not yet needed like the unborn child - or no longer needed - likethe elderly. See https://www.papafrancesco.net/
la-cultura-dello-scarto-le-persone-trattate-comedei-rifiuti/. A. Mariani, Papa Francesco: no alla
“cultura dello scarto (Pope Francis: no to the“throwaway culture”), IF Press, 2015.
htt p://www.sanita.sm /on-line/home/ bioetica/
comitato-sammarinese-di-bioetica/documents-inenglish.html
https://en.unesco.org/themes/ethics-science-andtechnology/bioethics-and-human-rights
According to Eurostat (EU-SILC 2018), there areabout 87 million people with disabilities (aged
16 and over) living in private households in theEuropean Union. These data do not include persons
living in long-term care facilities (about 1,100,000)
and persons with disabilities below 16 years old(about 3,000,000). https://ec.europa.eu/eurostat/
web/income-and-living-conditions/publications
Eu ropean Disabilit y For um, Open Letter to
Leaders at the EU and in EU Countries: Covid-19– Disability Inclusive Response (http://www.edffeph.org/newsroom/news/open-letter-leaders-euand-eu-countries-covid-19-disability-inclusiveresponse) and other initiatives available at: http://
www.edf-feph.org/
UNESCO - International Bioethics Committee
and World Commission on the Ethics of Scientific
K nowle d ge a nd Te ch nolog y, S t a te me n t on
Covid-19: Ethical Considerations from a Global
Perspective: https://unesdoc.unesco.org/ark:/48223/
pf0000373115
European Group on Ethics in Science and New
Technologies, Statement on European Solidarity
and the Protection of Fundamental Rights in the
COVID-19 Pandemic: https://ec.europa.eu/info/
sites/info/files/research_and_innovation/ege/ec_
rtd_ege-statement-covid-19.pdf
DH-BIO, DH-BIO Statement on human rights
c o n si d e r a t i o n s r e le v a n t t o t h e C OV I D -19
pandemic: https://www.coe.int/en/web/bioethics/
covid-19
htt ps://www.who.int/ethics/topics/outbreaksemergencies/covid-19/en/
E. g., Catalonia (https://www.redaccionmedica.
com/contenido/images/recomanacions-suportdecisions-let.pdf.pdf.pdf.pdf.pdf.pdf)
E. g., Alabama (https://mh.alabama.gov/covid19-dd/), Mar yland (https://www.mhamd.org/
41

Journal of Philosophy and Ethics in Health Care and Medicine, No. 14, December 2020

38

39

40

41
42

43
42

coronavirus/get-help-now/living-with-mentalillness-during-covid-19-outbreak/), Pennsylvania(https://www.inquirer.com/health/coronavirus/),Tennessee (https://www.curesma.org/wp-content/
uploads/2020/03/Cure-SMA-Tennessee-Medicaid.
pdf).
See the articles (in Italian language) reporting thedebate between the SIAARTI and the National
Federation of Orders of Surgeons and Dentists(FNOMCeO) on the topic https://portale.fnomceo.
it/anelli-fnomceo-su-documento-siaarti-nostraguida-resta-il-codice-deontologico/ and https://
www.quotidianosanita.it/lavoro-e-professioni/
articolo.php?articolo_id=85358
In this period, the number of infected persons
reached an average of 4,000 to 5,000 per day.
ICU facilities were running out of beds, and thenumber of deaths increased, reaching 600 to 800
deaths daily. For example, review newspaper
reports during March and early April: https://www.ilsole24ore.com/art/coronavirus-italia-newsultime-notizie-aggiornamenti-10-aprile-ADxcpYJ,
https://www.repubblica.it/cronaca/2020/03/30/
news/coronav i r u s _bila ncio_ mor t i _ g u a r it i _positivi_100mila-252710050/ .
In Italy, the responsibility of long-term care lies
with the 20 regions within Italy, which often
define the typology of these services differently.
These services, financed by social, socio-health,and health funds, often created administrative
confusion, which made assessment difficult.The
most common abbreviations in the regions are the
RSA (Assisted Health Residences, which mainly
host non-self-sufficient elderly persons) and RSD(health residences for persons with disabilities,
which house persons with disabilities aged 18
and over). The ISS investigation analyzed RSAs
only while the preparation of a survey on RSD iscurrently underway.
https://www.epicentro.iss.it/en/coronavirus/sarscov-2-survey-rsa
Actually, this information is more precise, as the
WHO states: “The incubation period of COVID-19,
which is the time between exposure to the virus
and symptom onset, is on average 5-6 days, but
can be as long as 14 days” see https://www.who.int/
news-room/commentaries/detail/transmission-ofsars-cov-2-implications-for-infection-preventionprecautions .
The Italian Disability Forum, an Italian memberof the European Disability Forum, continuing its

meritorious work of alternative reporting to the
UN Conventions ratified by Italy, denounced thecruel, inhuman and degrading treatment to which
persons with disabilities were subjected during the
SARS-COV19 in Italy, presenting an alternative
report to the UN Committee of the Convention
Against Torture and Other Cruel, Inhuman or
Degrading Treatment or Punishment) which
this year examined the official Italian report.
See the web site of the UN High Commissioner
on Human Rights https://tbinternet.ohchr.org/_
layout s /15/ Tr e at yBo dyEx t e r n a l /C ou nt r ie s.
aspx?CountryCode=ITA&Lang=EN .
44 S e e h t t p s: // w w w. a d n k r o n o s . c o m /s a l u t e /sanita/2020/10/20/covid-allarme-nelle-rsa-mancanomedici-infermieri_x79021dpeT5xMwkaF9qdVN.
html .
45 T here a re hu nd red s of complai nt s f iled byfamily members of persons who died in nursing
homes due to COVID-19. The complaints ask toinvestigate the lack of protection systems whose
absence has allowed the massive spread of thecoronavirus in these places and the consequent
deaths of their relatives. See as example https://www.ilgiorno.it/morti-rsa-1.5188910 and https://www.lastampa.it/torino/2020/04/21/news/troppianziani-morti-nelle-rsa-per-il-coronavirus-primedenunce-da-parte-dei-parenti-1.38745162 .
46 See Guarantor Announcements, in particular, thatof 12 March 2020: http://www.garantenazionale
privatiliberta.it/gnpl/ .
47 Five deaths and 162 infections among doctors,
nurses, assistants and patients were recorded in thescientific research and treatment institute (IRCCS)‘Oasi Maria Santissima’ in Troina, Sicily, residence
for the mentally disabled. The Region has sent an
emergency commissioner to the facility, and nurses
and doctors from the Army and Navy have been
deployed. See the following articles. https://www.
ansa.it/sicilia/notizie/2020/04/01/oasi-troina-mortaospite-112-positivi_8427ba29-06ee-4cdc-a4151cbc9f2fa322.html and https://palermo.repubblica.
it/cronaca/2020/04/14/news/coronavirus_focolaio_
all_oasi_di_t roina _la _ procura _indaga _ per_omicidio_ed_epidemia_colposi-253991754/ .
48 The Italian Federation for Overcoming Handicap(FISH, www.fishonlus.it) and the Federation of
the National Association on Disability (FAND,
www.fandnazionale.it) are the main representative
organizations in Italy that represent the majorityof the association of persons with disabilities andSARS-COVID-19 Pandemic and Persons with Disabilities in Italy and Europe ﻿

their families.
49 Appointed by the DPCM (Decree of the Presidencyof the Council of Ministers) on April, 10 2020.
50 See web site https://www.euro.who.int/en/healthtopics/health-emergencies/coronavirus-covid-19/
statements/statement-invest-in-the-overlooked-andunsung-build-sustainable-people-centred-longterm-care-in-the-wake-of-covid-19 .
51 S e e h t t p s : / / e c . e u r o p a . e u / c o m m i s s i o n /commissioners/2019-2024/dalli/announcements/
speech-commissioner-dalli-impact-coronavirusoutbreak-persons-disabilities_en .
52 See web site http://www.internationaldisability
alliance.org/covid-drm .
53 See note 18. “The report sets out the outcomesof a rapid human rights-based global monitoring
initiative – the COVID-19 Disability Rights Monitor(COVID-DRM) – sponsored by a consortiumof seven leading disability rights organizations,which took place between 20 April and 8 August
this year [2020], including the testimonies of 2,152
respondents from 134 countries, predominantly
from persons with disabilities themselves. The
report draws the worrying conclusion that states
have overwhelmingly failed to take sufficientmeasures to protect the rights of persons withdisabilities in their responses to the pandemic”.
The EU has the majority of responses, from
Western Europe (515) and Southern Europe (330).
54 See web site of Inter national Disability andD e v e l o p m e n t C o n s o r t i u m , h t t p s : // w w w.
iddcconsortium.net/ . The IDDC has conducted
research in developing Countries on pandemics anddisability.
55 See https://disabilityrightsfund.org/ .
56 See https://www.up.ac.za/ .
57 Details of the research and bibliography areavailable on web site https://www.apa.org/topics/
covid-19/research-disabilities .
58 See https://researchbriefings.files.parliament.uk/
documents/CDP-2020-0101/CDP-2020-0101.pdf .
59 See https://data.unicef.org/topic/child-disability/
covid-19/ .
60 See ht t ps://aahd.us/dissemination /covid-19disability-survey/ .
61 K . C o u r t e n a y, B. Pe r e r a , C OV I D -19 a n dpeo ple with intellectual disabilit y: im pact sof a pandemic, pp. 23-236, in Irish Journal of
Psychological Medicine, vol. 37, issue 3, September
2020, Special issue. COVID-19 perspectives,
ht t p s: // w w w.c a mb r id ge.o r g /c o r e /jou r n a l s /Giampiero GRIFFO, Luisa BORGIA

irish-journal-of-psychological-medicine/article/
covid19-and-people-with-intellectual-disabilityimpacts-of-a-pandemic/EE2156045429D885B49CBBBEBA5A96C5 .
62 See the data of the educational year 2016-17 fromthe European agency on special need and inclusive
education that report that the 99,2% of pupil withdisabilities in Italy studies in ordinary classes,
https://www.european-agency.org/.
63 Nuova Secondaria Ricerca. Mensile di cultura,
ricerca pedagogica e orientamenti didattici, n°
2, ottobre 2020, Dossier I, La scuola durante e
dopo il COVID, ed. Studium, Brescia, http://www.
edizionistudium.it/riviste/categorie/Nuova%20
Secondaria%20Ricerca .
64 See https://www.ohchr.org/Documents/Issues/
Disabilit y/COV I D -19_ a nd _T he_ R ig ht s _of _Persons_with_Disabilities.pdf .
65 Se e ht t ps://w w w.u n.org /developme nt /de sa /disabilities/covid-19.html .
66 Remember the def inition of disability in thepreamble) of the CRPD: “disability results from theinteraction between persons with impairments andattitudinal and environmental barriers that hinders
their full and effective participation in society on
an equal basis with others”; if you replace the term
“impairment” with features such as skin color,homosexual orientation, female gender, ... it isunderstood how society can impede those people incarrying out activities and accessing the rights.
67 The quality of life of persons with disabilities
depends on enjoying equal opportunity and accessto rights and benefits of a society that continually
strives to support and o v e r c o m e b a r r i e r s a n d
discrimination, as well as helping to foster amore positive perception of concerned persons,see C. Francescutti, Disability and Happinessp.251-266 in Minority Reports n. 6, JanuaryJune 2018, Par ticipation and Innovation, see
http://mimesisedizioni.it/riviste/minority-reports/
minority-reports-06.html .
68 Among these, the most representative philosopher
is Peter Singer. Singer’s approach (P. Singer,
Practical Ethics. Cambridge University Press; P.
Singer, Should the Baby Live? Oxford University
Press, 1985) is similar to that of the Nazis who
considered certain categories of persons (persons
with disabilities, Jews, mentally ill, Roma andSinti, etc.) unneeded, considering them uselesslives. The difference is that the Nazis were
motivated by the purity of the race (but not only)43

Journal of Philosophy and Ethics in Health Care and Medicine, No. 14, December 2020and Singer by the use of resources for the goodof the majority of the population. However, theseapproaches violate the substance of the humanrights paradigm - a global paradigm after the
Universal Declaration of Human Rights (1948)- which underscores that from the moment ofbirth, every human being, regardless of his or
her characteristics, enjoys all human rights: “Allhuman beings are born free and equal in dignity
and rights “...
* Websites accessed on 10 January 2021.

44