Ethical and legal aspects of triage in times of COVID-19 epidemic

ABOUT THE PROJECT

In several countries the Covid-19 pandemic has caused situations in which the health care system was severely overburdened. In such situations different collisions of duties appear: due to a shortage of personnel, technical equipment or other resources, adequate medical care cannot be provided to all of the patients that would need it. Such situations may cause an immense burden to decision-makers, who are put in a position to choose whom to offer a chance of survival. This kind of choice opens complex ethical and legal dilemmas, which have been in the past addressed mostly on the basis of hypothetical scenarios. The Covid-19 crisis has urged us to rethink those issues and to offer clear and transparent answers to ethical and legal challenges, with which we are faced as a society.

Funders:
Slovenian Research Agency  
Ministry of Health

Project number: V5-2037 (B)

1. 10. 2020 – 31. 10. 2022

 

 

CONTENT

The main aim of the research project is to explore, what are the potential solutions to the question, how to allocate limited medical resources (personnel or other resources), when medical care cannot be provided to all in the time of epidemics, in particular:

1) to evaluate what are the ethical and value-based underpinnings of medical triage in conditions of overburdened healthcare system;

2) to examine potential legal consequences of triage decisions and international legal practices of evaluating such decisions-making;

3) to examine the response of criminal law system in situations of so-called collisions of duties (when an overburdened individual is unable to fulfil all binding obligations);

4) to analyze domestic and foreign guidelines and recommendations of various (medical) associations and ethics commissions or councils addressing the issue of triage during the coronavirus epidemic, and present their commonalities and differences,

5) to explore the backgrounds of triage reasoning and to examine how practitioners, who are deciding to whom to provide help and to whom to reject it, respond psychologically to the difficult decisions they are making;

6) to examine the concept of advance expressed will and its impact on triage dilemmas;

7) to develop proposals of solutions for ethically challenging dilemmas.

RELEVANCE TO THE DEVELOPMENT OF SCIENCE:

The issues addressed by our research are of paramount importance to decision-makers, general and professional public and patients. They alleviate the heavy psychological burden of the medical staff, who have to make decisions under time pressure and in stressful circumstances. Although the questions are delicate and controversial, discussing them is crucial to ensure transparency of the health sector. Legitimate answers to the ethical and legal questions of triage are also important for patients and their relatives (users) because they bring predictability into uncertain situations and thus alleviate anxiety. Last but not least, findings of the research will also be useful for the drafters of guidelines and recommendations in Slovenia and the criminal justice system. Abroad, law enforcement agencies are already dealing with some controversial cases in regards to providing medical care in the time of epidemic. Our research will address issues of criminal responsibility in the context of Slovenian legal system, prosecutors and judges will be able to rely on its findings. In doing so, we will proceed from an important starting point, that the criminal law should only be a final tool of social policy in this area.

Project team

PROJECT RESULTS
  • Mišič L., & Strban G. (2021). Regulation of Triage in Times of a Pandemic: Experiences from Slovenia (and Beyond). Medicine, Law & Society, 14(2). https://doi.org/10.18690/mls.14.2.189-208.2021
  • Mišič, L., Strban G. (2020) Triaža: kjer se pravo in medicina razideta? Pravnik, 137 (11-12), 747-762.
  • Mišič, L. (2020) Metamorfoze pacientovih pravic v kriznih časih. Pravna praksa: časopis za pravna vprašanja, 39 (45), pril. str. I-.
  • Briški, L., Ambrož, M., Salecl, R. (2020) Koga reševati v času pandemije? Etični in kazenskopravni vidiki triaže. Revija za kriminalistiko in kriminologijo, 71 (3), 183-193.

Inštitut za kriminologijo in Svet za razvoj pri SAZU sta 24. 11. 2020 organizirala posvet z naslovom »Koga reševati v času pandemije? Etični, medicinski in kazenskopravni vidiki triaže«. Na posvetu so sodelovali strokovnjaki s področij medicine, prava, filozofije in drugih ved, in sicer: doc. dr. Tit Albreht, prof. dr. Matjaž Ambrož, akademik prof. dr. Valentin Hribar, prof. dr. Alojz Ihan, izr. prof. dr. Matjaž Jereb, prof. dr. Dušan Keber, doc. dr. Tatjana Lejko Zupanc, doc. dr. Luka Mišič, izredni član SAZU prof. dr. Marko Noč, prof. dddr. Andrej Pleterski, prim. Helena Reberšek Gorišek, dr. med., akademik prof. dr. Blaž Rozman, izredna članica SAZU prof. dr. Renata Salecl, prof. dr. Brigita Skela Savič, akademikinja prof. dr. Alenka Šelih, prof. dr. Mirjana Ule, doc. dr. Božidar Voljč. Organizatorja posveta sta bila izredna članica SAZU prof. dr. Renata Salecl in prof. dddr. Andrej Pleterski ZRC SAZU.

  • Renata Salecl (intervjuvanec). Studio City. Dostop na https://4d.rtvslo.si/arhiv/studio-city/174734522
  • Luka Mišič (intervjujanec). Studio City. Dostop na https://4d.rtvslo.si/arhiv/studio-city/174736268
  • Matjaž Ambrož (intervjuvanec). Od nikogar ni mogoče pričakovati, da stori nemogoče. Profesor kazenskega prava dr. Matjaž Ambrož o kazenskopravnem vidiku triaže. Dostop za registrirane uporabnike na https://www.delo.si/novice/slovenija/od-nikogar-ni-mogoce-pricakovati-da-stori-nemogoce/
  • Luka Mišič (intervjuvanec). Glavni izziv je omejitev dostopa do zdravnika. Odpoved zdravniškega pregleda lahko pomeni kršitev pacientovih pravic, ni pa nujno to tudi protipravno. Dostop za registrirane uporabnike na https://www.delo.si/novice/slovenija/glavni-izziv-je-omejitev-dostopa-do-zdravnika/
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