CYIL vol. 12 (2021)

CYIL 12 (2021) CZECH EXPERT STATEMENTS ON PATIENT PRIORITISATION IN THE COVID-19… The maximisation of benefits is regarded as the most important principle, 30 clearly suggesting the authors’ inclination towards utilitarianism as the ethical basis for their recommendations. The benefits should be best understood as the numbers of saved lives since in an acute crisis there is no time for careful assessment of the quality of survivors’ lives. In the outlined circumstances, care can be denied to patients who explicitly wish for it (and who would obtain it under normal conditions). 31 According to the Framework, the fairness principle should rather not consist in the first come, first served rule, since it could lead to overcrowding of the hospitals, discrimination of patients who live far from health facilities, or unreasonable prioritisation of patients with worse prognosis. 32 The principle of supporting the “helpers” is understood as a concretization of the maximisation of benefits. The value of the “helpers” (such as physicians, policemen, firefighters, etc.) is rather instrumental in this context – they need to be protected so they can keep helping others. 33 These essential workers should, therefore, have priority in the allocation of scarce resources. 34 The fourth principle arguably leads to even more controversial recommendations. The very basis of triage consists in the prioritisation of those whose health condition is urgent yet hopeful. Nevertheless, the Framework goes beyond this principle and argues that also younger patients should be prioritised. 35 They argue that such a rule does not represent discrimination on the grounds of age. It is rather supposed to reflect the fact that death is worse for a younger person since they lose more of a lifetime. 36 This line of thinking is based on the deprivation theory of death according to which death is not bad in itself, but because it deprives the deceased of all possible good things they could have experienced in life. While it is a very influential philosophical concept, 37 its direct application in law would apparently be of utmost controversy. The authors believe that patient prioritisation has nothing to do with the standard of care. According to them, prioritisation simply denotes deciding what type of care will be provided to which patient; after this decision-making process is completed, the relevant type of care must always be provided accordingly to its standard. 38 The Framework uses the principle “ ad 32 Apart from the Framework, p. 9, see also DOLEŽAL, Tomáš. Pravidlo first come, first served – kde se vzalo a kdy platí [The First Come, First Served Rule – Where It Came From and When It Is Applicable]. Zdravotnické právo a bioetika. (6 November 2020.) accessed 10 June 2021. 33 See 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. 9 . 2 nd ed. Kabinet zdravotnického práva a bioetiky Ústavu státu a práva AV ČR. (October 2020.) accessed 10 June 2021. 30 See ibid., p. 9. 31 Ibid.

34 See ibid., p. 10. 35 See ibid., p. 9. 36 See ibid., p. 13.

37 See for example NAGEL, Thomas. Mortal Questions. Cambridge University Press, Cambridge 1979, pp. 1–10. 38 See 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

351