CYIL vol. 12 (2021)

petr šustek CYIL 12 (2021) impossibilia nemo obligatur ” (nobody is obliged to the impossible) which we also know from the Statement, but here, its application is wider. The difference in both approaches could be explained in the following way: a) the Statement requires that prioritisation criteria are safely approved by the law and the principle that one cannot be obliged to the impossible simply means that compliance with these criteria cannot give rise to legal liability, but b) the Framework is based on the assumption that the factual impossibility to provide necessary care to every patient means that the law provides health providers and professionals with a wide margin of appreciation for defining their own prioritisation criteria (if they are not directly against the law, for example for being impermissibly discriminatory). 39 From the legal point of view, the Framework suggests that the concept of the conflict of obligations could be used to justify prioritisation. While it is not explicitly included in Czech statutory law or case law, nothing prevents the courts from deducing it as a “new” legal defence, especially with regard to its use in some other jurisdictions. 40 According to the Framework, the prioritisation criterion of the likelihood of therapeutic success is completely legitimate in this context. A much more difficult situation might arise in connection with the ex-post prioritisation, e.g., withdrawal of care. In this specific context, the Framework is almost as cautious as the Statement and recommends to never withdraw life-sustaining care unless it is futile for the patient. Nevertheless, it still claims that it is admissible to fasten the process of withdrawal in the situation of the lack of resources. 41 Based on the outlined principles, the Framework encompasses relatively detailed algorithms for patient prioritisation. 42 It is necessary to prioritise the patients who will likely be saved over those who only have a little chance to be cured, and the least priority should be given to patients who are likely to recover at home. 43 In each category, essential workers and younger patients should have priority. If it is not possible to prioritise according to these criteria, the Framework suggests drawing lots (as a procedure fully dependent on chance). 44 in the Provision of Health Services in the COVID-19 Pandemic], p. 20 . 2nd ed. Kabinet zdravotnického práva a bioetiky Ústavu státu a práva AV ČR. (October 2020.) accessed 10 June 2021. 39 See ibid., p. 21. 40 For example in Germany. For a closer justification of this legal defence in the context of patient prioritisation, see DOLEŽAL, Tomáš. Konflikt povinností jako okolnost vylučující protiprávnost – východisko pro úvahy o možné prioritizaci pacientů v případě nedostatku zdrojů [The Conflict of Obligations as a Legal Defence – a Framework for Considerations on Possible Patient Prioritisation in Case of the Lack of Resources]. Zdravotnické právo a bioetika. (2 November 2020.) accessed 10 June 2021. 41 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. 22 . 2 nd ed. Kabinet zdravotnického práva a bioetiky Ústavu státu a práva AV ČR. (October 2020.) accessed 10 June 2021. 42 See ibid., pp. 12–14, 22–23. 43 See ibid., p. 9. 44 See ibid., pp. 12–14.

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