CYIL vol. 12 (2021)
petr šustek CYIL 12 (2021) reminder that the great possibilities of modern medicine are nevertheless inherently limited. While some health professionals and patients’ relatives might tend to forget it, death does not always mean a lost battle. It can even be a medical and humane success if the dying person was treated with quality care, compassion, and dignity. Every patient has a right to be provided with health services on the appropriate professional level, i.e., according to the rules of science and acknowledged medical procedures with the respect to the individuality of the patient and with regard to the particular conditions and objective possibilities (as the standard of care is defined in Section 4(5) of Act No. 372/2011 Sb., on Health Services). Nevertheless, when scarce resources are depleted, the normal standard of care can be limited in a manner that is necessary in an individual case to keep the highest possible quality of health care. Such a limitation will still be considered compliant with the appropriate professional level since there the principle “ ad impossibilia nemo obligatur ” (nobody is obliged to the impossible) is applied. Nevertheless, scarce resources allocation might interfere with the patient’s constitutional rights such as the right to the protection of health under Article 31 of the Czech (constitutional) Charter of Fundamental Rights and Freedoms. It must be therefore subjected to several criteria. Perhaps most obviously, any discrimination based on criteria that are not directly connected with the presumed clinical outcome of care is forbidden. The Statement contains a demonstrative list of these impermissible discrimination grounds: social inequality, race, sex, disability, or sole age). 13 In a way similar to many other rationing guidelines, 14 the Statement does not explicitly refer to utilitarian philosophy 15 as its source of inspiration but it can be easily tracked in the principle of maximum achievable effect according to which health resources should be used for the greatest number of patients with the greatest effect of provided treatment. 16 In the context of the Statement, however, this proclamation seems to have a rather little practical effect since it is of paramount importance that each patient is evaluated based on their own health needs and prognosis and nobody can be denied necessary care in order to save others (as we will discuss below). According to Section 48(3) of Act No. 372/2011 Sb., on Health Services (Act on Health Services), the health services provider cannot deny admission to a patient who needs urgent care. This also applies if the admission means that the tolerable workload in the hospital will Vladimír. Stanovisko výboru ČSARIM 13/2020: Rozhodování u pacientů v intenzivní péči v situaci nedostatku vzácných zdrojů [Decision-making in patients in Intensive Care in the Situation of Lack of Scarce Resources]. Anesteziologie a intenzivní medicína. (2020, Vol. 31, No. 5), p. 250. 13 See ibid., p. 250. 14 Including, among others, the below-mentioned Swiss Academy of Medical Sciences guidelines that emphasize the ethical principle of preserving as many lives as possible and arguably are significantly utilitarian without explicitly acknowledging it. See Swiss Academy of Medical Sciences. Intensive care triage under exceptional resource scarcity. Revised version 4 . (23 September 2021.)
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