Alabama’s plan to prioritize who gets a ventilator in a pandemic is facing a legal and ethical challenge, as advocates argue it’s unlawful and unfair to keep people with intellectual and developmental disabilities off the list.

"You're singling out a group of people and the policy is really based on a value judgment that the lives of people with cognitive or intellectual disabilities are less worth living," Rhonda Brownstein, legal director of the Alabama Disabilities Advocacy Program, said in a phone interview Wednesday.

The Alabama Disabilities Advocacy Program and The Arc of the United States advocate on behalf of people with intellectual and developmental disabilities. The two nonprofits filed a federal complaint on Tuesday.

Alabama public health documents currently list "severe or profound mental retardation,” dementia and brain injury as among many potential reasons to be denied a ventilator in a crisis.

The nonprofits argue that Alabama's protocol violates the American with Disabilities Act and other federal laws. They filed the complaint with the U.S. Department of Health and Human Services Office for Civil Rights on Tuesday, arguing that Alabama's protocol puts disabled peoples' lives at risk.

The complaint calls on the federal office to "take immediate action to address this discrimination and assist covered entities in developing non-discriminatory approaches before there are lethal consequences from the application of these illegal policies."

As AL.com reported on Tuesday, the Alabama Department of Public Health issued an updated version of the protocol, dubbed “Criteria for Mechanical Ventilator Triage Following Proclamation of Mass-Casualty Respiratory Emergency,” in 2010. It outlines statewide recommendations for how hospitals should manage access to ventilators during a severe health crisis like a pandemic.

It lists a number of health conditions that could lead to a patient being denied access to a ventilator in an overwhelmed Alabama hospital during a health emergency. The health issues include heart attack, metastatic cancer, "severe or profound mental retardation,” “moderate to severe dementia,” and “severe traumatic brain injury.”

The last three diagnoses concern advocates.

"That's not only wrong, it's also illegal because federal law prohibits allocating medical treatment based on a person's disability, which is exactly what this policy does," said Brownstein.

A number of other states, including coronavirus hot-spot Washington, have their own ventilator rationing protocols in place. A similar challenge to the Washington protocol was lodged on Monday, and Brownstein said she expects to see advocacy organizations follow in their footsteps in states across the nation.

Under federal law, the federal government must investigate such complaints and determine if anyone's rights were violated.

A potential resolution lies in federal action, Brownstein said.

“What we ask for is that the Department of Health and Human Services issue guidance to states and that’s what’s missing,” she said. “States should not be left on their own to make these very, very difficult judgments; the federal government needs to step in and issue guidance.”

The Alabama Department of Public Health did not respond to a request for comment.