Allocation of scarce resources in a pandemic

Česká verzia

Authors: David Černý; Tomáš Doležal
Authors place of work: Ústav státu a práva AV ČR, v. v. i.
Published in the journal: Čas. Lék. čes. 2021; 160: 47-51
Category:

Summary

The allocation of scarce medical resources during a pandemic is one of the most challenging medical doctors' decisions. Although these decisions are based on the best medical knowledge and lege artis practice, they are inextricably intertwined with ethical and prudential (related to the patients' well-being) values. This article stresses the importance of ethical decision making during the whole process of allocation. First, it sets out to lay down a set of moral principles governing the allocation of scarce resources (mechanical ventilation, ECMO, etc.). This way it paves the way for more concrete ethical recommendations. Second, it analyses and describes in elaborate detail the criteria for admission to the ICU and two triage phases. The first reflects egalitarian concerns, and the second considers age as a proxy for the badness of death and other age-related considerations. Lastly, the paper offers a legal analysis of the process of allocation in the context of the Czech legal system.

Keywords:

triage – allocation – scarce resources – ethics – law – recommendations

Zdroje

Iserson KV, Moskop JC. Triage in medicine, part i: concept, history, and types. Ann Emerg Med 2007; 49: 275–281.
Kirby J. Enhancing the fairness of pandemic critical care triage. J Med Ethics 2010; 36: 758–761.
Okorie N. Partiality, impartiality and the ethics of triage. Developing World Bioethics 2018; 19: 1–10.
Wagner M, Dahnke MD. Nursing ethics and disaster triage: applying utilitarian ethical theory. J Emergency Nursing 2015; 41: 300–306.
Baker R, Strosberg M. Triage and equality: An historical reassessment of utilitarian analyses of triage. Kennedy Institute of Ethics Journal, 1992; 2: 103–123.
Beauchamp TL, Childress JF. Principles of Biomedical Ethics (6^th ed.). Oxford University Press, New York, 2009.
Emanuel EJ, Persad G, Upshur R et al. Fair allocation of scarce medical resources in the time of Covid-19. N Engl J Med 2020; 382: 2049–2055.
Schmitz-Luhn B, Bohmeier A. (eds.). Priorisierung in der Medizin. Kölner Schriften zum Medizinrecht, vol 11. Springer, Berlin, Heidelberg, 2013.
Taupitz J. Verteilung medizinischer Ressourcen in der Corona-Krise: Wer darf überleben? MedR 2020; 38: 440–450.
Brech A. Triage und Recht. Patientenauswahl beim Massenanfall Hilfebedürftiger in der Katastrophenmedizin. Ein Beitrag zur Gerechtigkeitsdebatte im Gesundheitswesen, Schriften zum Gesundheitsrecht (SGR), Band 11. Dunker, Humblot, Berlin, 2008.
Deutsche Interdisziplinäre Vereinigung Für Intensiv- und Notfallmedizin. Entscheidungen über die Zuteilung intensivmedizinischer Ressourcen im Kontext der COVID-19 Pandemie. Vers. 2. 2020. Dostupné na: www.divi.de/empfehlungen/publikationen/covid-19-dokumente/covid-19-ethik-empfehlung
Černý D, Doležal A, Doležal T. Etická a právní východiska pro tvorbu doporučení k rozhodování o alokaci vzácných zdrojů při poskytování zdravotních služeb v rámci pandemie COVID -19. Ústav státu a práva, Praha, 2020. Dostupné na: https://zdravotnickepravo.info/eticka-a-pravni-vychodiska-pro-tvorbu-doporuceni-k-rozhodovani-o-alokaci-vzacnych-zdroju-pri-poskytovani-zdravotnich-sluzeb-v-ramci-pandemie-covid-19-aktualizovane-vydani
Savulescu J, Vergano M, Craxi L, Wilkinson D. An ethical algorithm for rationing life-sustaining treatment during the COVID-19 pandemic. Br J Anaesth 2020; 125: 253–258.
Černý D. Alokace na základě věku a diskriminace. In: Šejvl M a kol. Vítězové a poražení: Právní a etické problémy současné koronakrize. Ústav státu a práva, Praha, 2020. Dostupné na: www.ilaw.cas.cz/upload/web/files/books/VITEZOVE_PORAZENI_final.pdf
Bradley B. Well-Being & Death. Oxford University Press, New York, 2011.
Daniels N. Just Health Care. Cambridge University Press, New York, 1985.
Daniels N. Just Health. Meeting Health Needs Fairly. Cambridge University Press, New York, 2008.

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Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental Hygienist

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