School of Law, University of Reading, Reading, Berkshire, UK
Ethox Centre, University of Oxford, Oxford, UK.
J Med Ethics. 2020 Oct;46(10):646-651. doi: 10.1136/medethics-2020-106487. Epub 2020 Aug 7.
Tragic choices arise during the COVID-19 pandemic when the limited resources made available in acute medical settings cannot be accessed by all patients who need them. In these circumstances, healthcare rationing is unavoidable. It is important in any healthcare rationing process that the interests of the community are recognised, and that decision-making upholds these interests through a fair and consistent process of decision-making. Responding to recent calls (1) to safeguard individuals' legal rights in decision-making in intensive care, and (2) for new authoritative national guidance for decision-making, this paper seeks to clarify what consistency and fairness demand in healthcare rationing during the COVID-19 pandemic, from both a legal and ethical standpoint. The paper begins with a brief review of UK law concerning healthcare resource allocation, considering how community interests and individual rights have been marshalled in judicial deliberation about the use of limited health resources within the National Health Service (NHS). It is then argued that an important distinction needs to be drawn between procedural and outcome consistency, and that a procedurally consistent decision-making process ought to be favoured. Congruent with the position that UK courts have adopted for resource allocation decision-making in the NHS more generally, specific requirements for a procedural framework and substantive triage criteria to be applied within that framework during the COVID-19 pandemic are considered in detail.
在 COVID-19 大流行期间，当急性医疗机构提供的有限资源无法供所有需要的患者使用时，就会出现悲惨的选择。在这种情况下，医疗资源配给是不可避免的。在任何医疗资源配给过程中，重要的是要认识到社区的利益，并通过公平和一致的决策过程来维护这些利益。针对最近的一些呼吁（1）在重症监护决策中保护个人的合法权利，以及（2）为决策制定新的权威国家指南，本文试图从法律和伦理角度澄清在 COVID-19 大流行期间医疗资源配给中一致性和公平性的要求。本文首先简要回顾了英国有关医疗资源分配的法律，考虑了社区利益和个人权利如何在英国国民保健制度（NHS）内部使用有限卫生资源的司法审议中得到体现。然后认为，需要在程序一致性和结果一致性之间做出重要区分，并应赞成程序一致的决策过程。与英国法院在 NHS 更广泛的资源分配决策中采取的立场一致，本文详细考虑了在 COVID-19 大流行期间在该框架内适用的程序性框架和实质性分诊标准的具体要求。
