Healthcare resource allocation decisions and non-emergency treatments in the aftermath of Covid-19 pandemic. How should children with chronic illness feature in prioritisation processes?
Healthcare resource allocation decisions and non-emergency treatments in the aftermath of Covid-19 pandemic. How should children with chronic illness feature in prioritisation processes?
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DOI：
10.12688/wellcomeopenres.19571.1
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发表时间：
2024-01-16
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在2019年冠状病毒病(新冠肺炎)大流行之后，分配非紧急医疗干预措施是一个持续的道德挑战，因为卫生系统目前面临前所未有的需要治疗的患者积压。必须做出艰难的决定，将某些患者优先于其他患者。合乎伦理的资源分配要求适当考虑所有患者的需要，但目前没有指导方针可以帮助支持这种明确考虑患有慢性病和复杂疾病的儿童的需要的决策。本文回顾了NHS关于优先事项和业务规划的指南，并研究了NHS如何在恢复服务和满足选择性护理需求的目标中解决慢性病儿童的需求。NHS指南中列出的优先顺序的通常标准没有考虑到患有慢性病的儿童的不同需求，也没有与公平资源分配决定的更一般考虑相匹配。为了解决这个问题，提出了两个考虑因素，即“保护与年龄相关的机会”和“认识到护理的复杂性”，作为现有方法的补充。通过提供更广泛的需求概念，这些标准解决了当前指导和相关道德框架的低效问题，并有助于将目前与失踪儿童有关的道德方法嵌入到总体医疗政策制定中。本文讨论了一个日益紧迫的实际问题，即在大流行后和面对大量等待治疗的名单时，在不同群体之间公正地分配医疗资源。我们的重点是患有复杂疾病的儿童，我们认为这是一个弱势群体，在政策考虑中一直处于系统性的不利地位。我们声称，目前的NHS方法没有成功地满足他们的独特需求。我们建议，“保护与年龄有关的机会平等”和“承认护理的复杂性”这两项新标准应与现有标准相辅相成，以支持决策者作出符合慢性病儿童需要的一致、公平和包容的决定。我们还考虑了我们建议的框架对一般卫生保健资源分配决策的更广泛的影响。我们希望，这项工作将使我们更好地从理论上了解大流行病之后及以后在资源分配决策方面面临的实际变化。
In the aftermath of the Coronavirus disease 2019 (Covid-19) pandemic, allocation of non-urgent medical interventions is a persistent ethical challenge as health systems currently face an unprecedented backlog of patients requiring treatment. Difficult decisions must be made that prioritise certain patients over others. Ethical resource allocation requires that the needs of all patients are considered properly, but at present there is no guidance that can help support such decision-making which explicitly considers the needs of children with chronic and complex conditions. This paper reviews the NHS guidance for priorities and operational planning and examines how the needs of children with chronic illness are addressed in NHS objectives for restoring services and meeting elective care demands. The usual criteria for prioritisation featured in the NHS guidance fail to account for the distinct needs of children with chronic illnesses and fail to match more general considerations of what constitutes fair resource allocation decisions. To address this issue, two considerations, namely 'protecting age-related opportunity' and 'recognising complexity of care,' are proposed as additions to the existing approach. By providing a broader conception of needs, these criteria address inefficiencies of the current guidance and relevant ethical frameworks and help to embed a currently missing children-related ethical approach to healthcare policy making in general. This paper addresses an increasingly pressing practical problem of justly allocating healthcare resources between different groups in the aftermath of the pandemic and in the face of significant waiting lists for treatment. Our focus is on children with complex conditions, a vulnerable group that we argue has been systematically disadvantaged in policy considerations. We claim that the current NHS approach does not succeed in capturing their distinct needs. We suggest that two new criteria ‘protecting age-related equality of opportunity’ and ‘acknowledging complexity of care’ should complement the existing ones in order to support decisions-makers to make decisions that are consistent, fair and inclusive to the needs of children with chronic conditions. We also consider broader implications of our suggested framework for health care resource allocation decisions in general. We hope that this work brings a better theoretical understanding closer to the practical changes faced in resource allocation decision making context in the aftermath of the pandemic and beyond.