A legal epidemiological study of patients' rights and healthcare rationing in England during the COVID-19 pandemic

NHS治疗的需求超过了供应。长期的资金限制和资源严重短缺的时期，包括工作人员，床位和设备，提出了关于患者的治疗权利和临床医生的NHS资源配给的影响的问题。这些担忧在2019冠状病毒病大流行的最初阶段加剧，当时人们认为医院和临床医生的资源优先次序指导存在重大局限性。有人认为，出于资源优先的目的而取消生命支持治疗的政策可能是非法的，（挽救最多的"生命年数"）可能构成对老年人和合并症患者的歧视。iii在没有政策的情况下，配给福尔斯落在临床医生个人身上，这就有不一致和对病人有偏见的内在风险，还有对临床医生造成道德伤害的风险。虽然配给管理需求激增是合理的，但这需要一个充分的法律的框架来保护患者和临床医生。iv Newdick、Sheehan和Dunn认为，患者在资源分配决定方面享有程序性权利，这可以通过分析与提供NHS治疗有关的早期法律的决定来阐明。他们建议，这应被用作指导地方资源分配决策的总体国家框架的基础，以保护患者的权利。v我提议的研究应用了这一理论框架，并使用了混合方法，包括法律的流行病学的新应用，以澄清患者接受NHS治疗的法律的权利，并确定COVID-19大流行期间配给政策/指导在多大程度上保护或减损了这些权利。NHS资源的持续压力表明，资源优先次序仍然是大流行后的重要问题，预计这项研究的结果将有助于政策制定者和临床医生在未来做出合法的资源分配决定。

Demand for NHS treatment outstrips supply. Long-term funding constraints and periods of acute scarcity of resources including staff, beds, and equipment, raise questions about patients' rights to treatment and the impact on clinicians of rationing NHS resources. These concerns intensified in the initial stages of the COVID-19 pandemic, when it was considered that resource prioritisation guidance for hospitals and clinicians had significant limitations.i For example, it has been argued that policies regarding withdrawal of life supporting treatment for resource prioritisation purposes may be unlawful and that a policy based on the ethical principle of utilitarianism (saving the most 'life-years') may amount to discrimination in respect of the elderly and patients with comorbidities. iii Where no policies exist, rationing falls to individual clinicians, with inherent risks of inconsistency and bias for patients, together with a risk of moral injury to the clinicians. While rationing to manage a surge in demand can be justified, this requires an adequate legal framework to protect patients and clinicians.iv Newdick, Sheehan and Dunn argue that patients have procedural rights in respect of resource allocation decisions, which can be elucidated through analysis of earlier legal decisions related to the provision of NHS treatment. They propose that this should be used as the basis for an overarching national framework to guide local resource allocation decision-making to protect patient rights. v My proposed research applies this theoretical framework and uses mixed methods, including a novel application of legal epidemiology, to clarify patients' legal rights to NHS treatment and to ascertain the extent to which policies/guidance on rationing during the COVID-19 pandemic protected or 3 derogated from those rights. The on-going pressure on NHS resources indicates that resource prioritisation remains an important issue post-pandemic and it is anticipated that the findings of this research will assist policy-makers and clinicians in making legally informed resource allocation decisions in future.