Discriminatory guidelines may have led to deaths as elderly were denied Covid-19 medication
Some elderly patients in Finland were denied access to the Covid-19 drug Paxlovid based solely on their age and place of residence, a practice now ruled discriminatory by the Deputy Parliamentary Ombudsman, Yle reports. The exclusion may have resulted in preventable deaths, according to the decision.
The investigation, concluded this week by Deputy Ombudsman Susanna Lindroos-Hovinheimo, found that guidelines issued by university hospital infectious disease specialists deviated from the legally grounded instructions provided by the Ministry of Social Affairs and Health. The specialists’ recommendation—stating that Paxlovid should not generally be prescribed to elderly patients in 24-hour care or institutional settings—was deemed unlawful and contrary to the rule of law.
The controversial guideline, introduced months after the ministry’s national recommendations in June 2022, explicitly stated: “Assessment for medication is generally not needed for elderly patients permanently in enhanced assisted living or institutional care.” Lindroos-Hovinheimo’s decision emphasised that this directive placed elderly individuals in a disadvantaged position based on age and housing status, without legal justification or acceptable purpose.
Regional disparities in prescription practices
The investigation revealed significant variation in how Finland’s 21 wellbeing services counties applied the guidelines. Seventeen counties and the Helsinki and Uusimaa Hospital District (HUS) initially followed the ministry’s instructions before adopting the university hospitals’ more restrictive recommendation. One county adhered only to the ministry’s guidelines, while another developed its own criteria without age limits. A fourth based its approach on international guidelines, explicitly rejecting age or housing status as limiting factors.
Lapland’s wellbeing services county was among those that refused to implement the discriminatory age-based restrictions. Markku Broas, then-head of infectious diseases for the region, criticised the limitations as ethically questionable in an October 2023 interview with Yle. “A doctor cannot play god in this matter,” he stated. “We cannot contribute to people’s deaths by deciding that someone is denied medication simply because they are old or live in a care home. It feels like the elderly are sometimes left untreated because of the assumption that they will die soon anyway.”
The Deputy Ombudsman’s ruling underscores that the university hospitals’ guideline lacked a legal basis and may have caused avoidable fatalities. While some regions resisted the discriminatory practice, the inconsistent application of rules highlights systemic failures in protecting vulnerable populations during the pandemic.