突发公共卫生事件中紧缺公共医疗资源分配的伦理方案与法律规则

The Ethics and Law of Allocation of Scarce Medical Resources in Public Health Emergencies

突发公共卫生事件导致公共医疗资源极度紧缺,在加大资源投入、减少资源浪费或紧急资源调配等措施均不敷所用之际,如何分配就成为无法回避的难题。从尊严主义、功利主义和平等主义三种道德立场出发,可以采用抽签、排队、预后、生命数量、生命年数、工具价值、互惠性、病情、年龄和经济地位等标准来确定医疗资源分配的优先级。但这些标准各有优劣,无法独立决定分配顺位,需要取舍和权衡,故有必要参考域外实践,本着公正、高效和动态的原则,结合多重标准,按照医护人员、先到者、病情更严重者、短期预后更佳者、被抽中者的顺位构建我国突发公共卫生事件中紧缺医疗资源分配的伦理方案。该方案需要法律规则的配套,应从立法形式、执行主体和救济机制三方面调整,完善相关法律制度,包括以软法形式出台统一分配规则、赋予医学伦理委员会决策职能以及畅通申诉、审查和诉讼渠道。

Public health emergencies lead to an extreme shortage of medical resources,When public health emergencies lead to an extreme shortage of medical resources that cannot be eased by measures such as increasing resource input,reducing resource waste or emergency resource deployment,how to allocate these resources becomes an unavoidable problem.How to allocate these resources becomes an unavoidable problem.From the three moral standpoints of deontology,utilitarianism and egalitarianism,criteria such as lottery,queuing,prognosis,number of lives,years of life,instrumental value,reciprocity,condition of illness,age and economic status can be used to determine the priority in allocation of scarce medical resources.However,each of these criteria has its own advantages and disadvantages and cannot be used independently to decide the priority in the allocation of medical resources,which means trade-offs and balancing among these criteria are inevitable.Therefore,it is necessary for China to draw on overseas experiences,base itself on the principles of fairness,efficiency and dynamics,combine multiple standards,and construct an ethical plan for the allocation of scarce medical resources in public health emergencies in the following order of priority:medical staff,first-comers,people with higher risk of infection or the more seriously infected,the better short-term prognosis,and the winners of lottery.The ethical plan also requires the establishment of supporting legal rules and the adjustment and improvement of relevant legal systems in the three aspects of the form rule-making,enforcement body and relief mechanism,including adopting a set of rules on the allocation of medical resources in the form of soft law,giving the decision-making function to medical ethic committees and unblocking the channels of complaint,review and litigation.