CYIL vol. 12 (2021)

petr šustek

CYIL 12 (2021)

Introduction In spite of several warnings against a possible epidemic coming from experts in the past, the Covid-19 pandemic seemed to have caught most countries unprepared. 2 The sudden influx of patients overwhelmed hospitals in many areas, forcing them to apply patient triage, i.e., selection algorithms aiming at excluding patients whose health condition is either too mild or too hopeless to be provided with scarce resources. 3 Nevertheless, most countries in Europe, North America, and other developed parts of the world have only known triage from war and disaster medicine in the last decades. It was not possible to apply it automatically in a very different context of inpatient care at hospitals in larger areas such as whole cities or regions. However, that was precisely what was necessary to do. As a result, health systems were forced to swiftly find and define criteria for patient prioritisation in a very specific context of the pandemic. In other words, they had to answer the question of whom to provide scarce resources (qualified personnel, medical devices, medicines, etc.) to when it was not possible to provide the best care to all the patients who would need it. In some countries, the legislature swiftly stepped in and provided at least a basic legal framework – we can recall the British Coronavirus Act of 2020. In most countries, however, the task was first taken on by professional medical or ethical bodies. This was also the case in the Czech Republic. Two statements were issued during the first pandemic year by different expert teams, containing contradictory advice. It would be very difficult if not impossible to judge which of the documents is “better” since both aim at partially different goals. Nevertheless, we will now introduce their contents and compare them with selected foreign guidelines. Last but not least, we will try to evaluate them on the basis of applicable international law rules. In Autumn 2020, the epidemiological situation in the Czech Republic was rapidly worsening. Being a victim of its own success in containing the contagion in the Spring, the country underestimated the threat in late Summer and was on its way to face the world’s highest Covid-19 death rate per capita for many months to come. 4 There were very real concerns about the possible exhaustion of hospital capacities which could lead to the collapse of the health system. At the same time, no criteria were defined for the allocation of scarce 2 See for example Ó MONGÁIN, Colm. Warnings about a global pandemic were ignored – then Covid-19 struck. RTE. (12 May 2021.) accessed 10 June 2021. 3 The concept of triage was first introduced by Napoleon’s chief surgeon Dominique Jean Larrey with the aim of saving as much wounded soldiers as possible, regardless their rank or social status. See for example ČERNÝ, David, DOLEŽAL, Adam, DOLEŽAL, Tomáš. Etická a právní východiska pro tvorbu doporučení k rozhodování o alokaci vzácných zdrojů při poskytování zdravotních služeb v rámci pandemie COVID-19 [Ethical and Legal Framework for the Creation of Guidelines for the Decisions Regarding Scarce Resources Allocation in the Provision of Health Services in the COVID-19 Pandemic], p. 10 . 2 nd ed. Kabinet zdravotnického práva a bioetiky Ústavu státu a práva AV ČR. (October 2020.) accessed 10 June 2021. 4 See KOTTASOVÁ, Ivana. How the Czech Republic slipped into a Covid disaster, one misstep at a time. CNN. (1 March 2021.) accessed 10 June 2021. 1. Statement of the Committee of the Czech Society of Anaesthesiology and Intensive Care Medicine


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