SEARCHING FOR A FAIR ALLOCATION OF SCARCE MEDICAL RESOURCES UNDER EU LAW: A NEED FOR BALANCE FOR THE ELDERLY?

Yıl 2023, Cilt: 22 Sayı: 1, 117 - 145, 21.07.2023

Gözde Kaya

https://doi.org/10.32450/aacd.1327050

Öz

Fair allocation of scarce medical resources during emergency situations such as the COVID-19 pandemic is a highly challenging task. The pandemic has revealed that age was invoked as a criterion in terms of granting access to medical treatment in some European Union countries such as Italy. This paper analyses whether or not the use of chronological age alone might be justified for any such differential treatment in the event of scarcity. The paper seeks to demonstrate that older persons should not be automatically excluded from receiving access to healthcare which might otherwise amount to direct discrimination under European Union law.

Anahtar Kelimeler

Age Discrimination, Scarce Medical Resources, Old Persons, COVID-19 pandemic, European Union Law

Kaynakça

• Alemanno, Alberto. “The European Response to COVID-19: From Regulatory Emulation to Regulatory Coordination?”, European Journal of Risk Regulation, 11, no.2, (2020): 307-316.
• Antoniou, Rea, Heather Romero-Kornblum, J. Clayton Young, Michelle You, Joel H. Kramer and Winston Chiong. “Reduced utilitarian willingness to violate personal rights during the COVİD-19 pandemic”, PLoS ONE 16, no.10, (2021):1-14. Accessed: 18 August 2022, http://doi.org/10.1371/journal.pone.0259110.
• Archard, Dave, Arthur Caplan, William F and Virginia Connolly, “Is it wrong to prioritise younger patients with Covid-19?”, BMJ, 369, (2020): 1-2.
• Biddison, Elizabeth Lee Daugherty, Howard S.Gwon, Monica Schoch-Spana, Alan C. Regenberg, et al., “Scarce Resource Allocation during Disasters: A Mixed-Method Community Engagement Study”, CHEST, (2017), doi.org/10.1016/j.chest.2017.08.001.
• Biddison, E. Lee Daugherty, Ruth Faden, Howard S. Gwon, Darren P. Mareiniss, et al. “Too Many Patients…A Framework to Guide Statewide Allocation of Scarce Mechanical Ventilation During Disasters”, CHEST, 155, no.4, (2019): 848-854.
• Brown, Matthew and J. Justin Goodwin. Correspondence, “Allocating Medical Resources in the Time of Covid-19”, The New England Journal of Medicine, 382, no. 22, (2020): E79(1)-E79(3).
• Browning, Heather and Walter Veit. “Utilitarian Lessons from the COVID-19 Pandemic for Non-Pandemic Diseases”, The American Journal of Bioethics, 21, no:12, (November 2021): 39-42.
• Buck, Nicholas. “COVID-19 and the Limits of Utilitarianism”, June 11 2020, Accessed: 17 June 2022, https://divinity.uchicago.edu/sightings/articles/covid-19-and-limits-utilitarianism.
• Cachia, Jean Claude. “The Europeanization of the Covid-19 Pandemic Response and the EU’s Solidarity with Italy”, Contemporary Italian Politics, 13, no.1, (January 2021): 81-104.
• Deen, Bob and Kimberley Kruijver, “Corona: EU’s existential crisis, Why the lack of solidarity threatens not only the Union’s health and economy, but also its security”, Clingendael, Netherlands Institute of International Relations, April 2020.
• Dewhurst, Elaine. Age Discrimination outside the Employment Field, European Network of Legal Experts in Gender Equality and Non-discrimination, European Commission, Directorate-General for Justice and Consumers, 2020.
• Dewhurst, Elaine. “Are Old Workers Past Their Sell-by-Date? A View from UK Age Discrimination Law”, The Modern Law Review, 78, no.2, (2015): 189-215.
• De Castro-Hamoy, Leniza and Leonardo D. De Castro, “Age Matters but it should not be Used to Discriminate Against the Elderly in Allocating Scarce Resources in the Context of COVID-19”, Asian Bioethics Review, 12, no.3, (2020): 331-340.
• Di Blasi, Erica., “Italians over 80 ‘will be left to die’ as country overwhelmed by coronavirus”, The Telegraph, March 14 2020, Accessed: 19 June 2022, https://www.telegraph.co.uk/news/2020/03/14/italians-80-will-left-die-country-overwhelmed-coronavirus.
• Domenici, Irene and Franciska Engeser, The Institutional Tragedy of Pandemic Triage Regulation in Italy and Germany, European Journal of Health Law, 29, no.1, (2022): 103-130.
• Drury, Elizabeth. “Age Discrimination Against Older Workers in the European Union”, The Geneva Papers on Risk and Insurance-Issues and Practice 19, no. 73, (1994): 496-502.
• Emanuel, Ezekiel J., Govind Persad, Ross Upshur, Beatriz Thome et al. “Fair Allocation of Scarce Medical Resources in the Time of Covid-19”, The New England Journal of Medicine, 382, no. 21, (May 21 2020): 2049-2055.
• Emre, Özge and Gürkan Sert, “Avrupa Hasta Hakları Şartı”, Türkiye Biyoetik Dergisi, 1, no.4 (2014): 198-205.
• “European Charter of Patients’ Rights”, Accessed: 10 April 2022, https://ec.europa.eu/health/ph_overview/co_operation/mobility/docs/health_services_co108_en.pdf
• Faggioni, Maurizio P., Fermin Jesus Gonzalez-Melado, Maria Luisa Di Pietro. “National Health System Cuts and Triage Decisions During the COVID-19 Pandemic in Italy and Spain: Ethical Implications”, J Med Ethics, no.47, (2021): 300-307.
• Giuffrida, Angela. “Why Lombardy was hit harder than Italy’s other regions?”, The Guardian, May 29 2020, Accessed: 20 July 2022, https://www.theguardian.com/world/2020/may/29/why-was-lombardy-hit-harder-covid-19-than-italys-other-regions.
• Greer, Scott L., Nick Fahy, Heather A. Elliott, et al. Everything you always wanted to know about the European Union health policies but were afraid to ask, European Observatory on Health Systems and Policies, United Kingdom: World Health Organization, 2014.
• Harper, Sarah. “The COVID-19 Pandemic and Older Adults: Institutionalised Ageism or Pragmatic Policy?”, Journal of Population Ageing no. 13, (2020): 419-425.
• Harris, John. The Value of Life, An Introduction to Medical Ethics, London: Routledge, 1985.
• Jansen, Lynn A. and Steven Wall, “Weighted Lotteries and the Allocation of Scarce Medications for Covid-19”, Hastings Center Report, 51, no.1, (2021): 39-46.
• Jaziri R. and S. Alnahdi, “Choosing which COVID-19 patient to save? The ethical triage and rationing dilemma”, Ethics, Medicine and Public Health, 15, (2020):1-12.
• Jones, Erik. “Italy and Europe: from competence to Solidarity to competence”, Contemporary Italian Politics, 13, no.2, (April 2021): 196-209.
• Joppe, Anne. “EU Solidarity, Illustrated by the Covid-19 Crisis: What does EU Solidarity mean in the context of free movement of goods and persons and how is this illustrated by the response to the Covid-19 pandemic?”, Utrecht Law Review, 17, no. 3, (2021): 130-142.
• Kaya, Gözde. “EU Age Discrimination in Light of EU’s Demographic Challenges and ECJ Case Law”, Dokuz Eylül Üniversitesi Hukuk Fakültesi Dergisi, 17, no 1 (2015): 79-117.
• Kaya, Gözde. “Age Discrimination as a Bone of Contention in the EU”, in The European Union as Protector and Promoter of Equality, ed. Thomas Giegerich, 391-415. Switzerland: Springer, 2020.
• Kurrer, Christian. Public Health, Fact Sheets on the European Union, European Parliament, March 2021. Accessed: 12 March 2022, europarl.europa.eu/factsheets/en/sheet/49/public-health.
• Mary-Elise Manuell, Mary Dawn T. and Richard T. Ellison. “Pandemic Influenza: Implications for Preparation and Delivery of Critical Care Services”, J. Intensive Care Med., 26, no.6 (2011): 347-367.
• Montero-Odasso, Manuel, David B. Hogan, Robert Lam, et al. “Age Alone is not Adequate to Determine Health-care Resource Allocation During the COVID-19 Pandemic”, Canadian Geriatrics Journal, 23, no.1, (March 2020): 152-154.
• Morrow-Howell, Nancy and Ernest Gonzales, “Recovering from Coronavirus Disease 2019 (COVID-19): Resisting Ageism and Recommitting to a Productive Aging Perspective”, Public Policy & Aging Report, XX, no. XX, 2020.
• “No exceptions with Covid-19: ‘Everyone has the right to life-saving interventions’ – UN Experts say”, UN Human Rights Office of the High Commissioner, March 26 2020, Geneva, Accessed: 27 May 2022, https://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=25746&LangID=E.
• Piazza, Ornello, “Saving Limited Resources During Covid-19 Pandemic”, Translational Medicine, 23, no.4, (2020): 20-21.
• Renda, Andrea and Rosa Castro, “Towards Stronger EU Governance of Health Threats after the COVID-19 Pandemic”, European Journal of Risk Regulation, 11, no.2, (2020): 273-282.
• Rivlin, Michael M. “Why the Fair Innings Argument is not Persuasive?”, BMC Medical Ethics, 1, (2000): 1-6.
• Savulescu, Julian, Ingmar Persson and Dominic Wilkinson, “Utilitarianism and the pandemic, Bioethics, 34, no.6, (2020): 620-632.
• Selles, David-Martinez, Helena Martinez-Selles and Manueal Martinez-Selles. “Ethical Issues in Decision-making Regarding the Elderly Affected by Coronavirus Disease 2019: An Expert Opinion”, European Cardiology Review, 15, (2020): 1-4.
• Statement of the European Commissioner for Equality, Helena Dalli on ‘Covid-19 and older people’, April 2 2020, Accessed: 10 June 2022; https://www.age-platform.eu/sites/default/files/Covid-19_%26_olderPeople-Dalli_statement-Apr20.pdf.
• The Letter of the three EU Commissioners to the Member States, April 8 2020, Accessed: 11 June 2022,https://www.age-platform.eu/sites/default/files/COVID-19-EUCommission_letter_to_ Ministers_Apr20.pdf.
• “The legislator must take effective measures ensuring that persons with disabilities are protected in triage situations caused by the pandemic”, Bundesverfassungsgericht, Press Release No.109/2021 of December 2021, order of 16 December 2021, 1 BvR 1541/20, pp.1-3.
• Vergano, Marco, Guido Bertolini, Alberto Giannini, Giuseppe R. Gristina, et al. “SIAARTI recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances”, Minerva Anestesiologica 86, no.5, (2020 May): 469-502, doi: 10.23736/S0375-9393.20.14619-4.
• Vergano, Marco, Guido Bertolini, Alberto Giannini, Giuseppe R. et al. “Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances: the Italian Perspective during the Covid-19 epidemic”, Critical Care, 24, no.165, (2020): 1-3.
• White, Douglas B. and Bernard Lo. “A Framework for Rationing Ventilators and Critical Care Beds During the Covid-19 Pandemic”, JAMA, 323 no.18, (March 27 2020): 1773-1774.
• White, Douglas B., Mitchell H. Katz, John M. Luce and Bernard Lo, “Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions”, Ann Intern Med., 150, no.2, 2009: 132-138.
• Zeneli, Anita, Giovanni Brandi, Giuseppe Di Pasquale, Danilo Orlandini et al. “Identifying ethical values for guiding triage decisions during the COVID-19 pandemic: an Italian ethical committee perspective using Delphi methodology”, BMJ Open, 11, (May 18, 2021): 1-10. Accessed: 16 June 2022, https://bmjopen.bmj.com/content/11/5/e043239.
• Zhu, Hengbo, Li Wei and Ping Niu. “The Novel Coronavirus Outbreak in Wuhan, China”, Short Report, Global Health Research and Policy, 5:6, (2020) 1, Accessed: 10 May 2022, https://ghrp.biomedcentral.com/track/pdf/10.1186/s41256-020-00135-6.pdf. doi: 10.1186/s41256-020-00135-6.