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1. Core Values to inform planning and decision making for health care delivery for all people in Wales

In addressing healthcare provision during the Covid19 Pandemic in Wales, the core value underpinning this ethical framework is ‘equal concern and respect’.

This promotes the core constitutional commitment to equality, and the protections for all people, enshrined in law in Wales in respect of governance and language.

This means that:

  • everyone matters –health service delivery will follow the principles set out in equality and human rights legislation
  • everyone matters equally – this does not mean that everyone is treated the same, but does require health services to work effectively in partnership with each person equitably according to their needs
  • the interests of each person are the concern of all of us, and of our society
  • the harm that might be suffered by every person matters, and so our actions aim to minimise the overall harm that a pandemic might cause

2. Using the framework to deliver health services equitably

The core value ‘equal concern and respect’ draws together a number of different ethical principles. When a particular decision has to be made, the following list of principles can be used systematically to help those delivering health services discharge their duty to ensure that the full range of ethical issues is considered.

3. Principles and law underpinning ethical delivery of health care

Respect

 Means:

  • holding a view of the person as a whole, taking into account their rights, wishes and feelings as a unique individual
  • keeping people as informed as possible, ensuring that communications are available in accessible formats in their preferred language
  • giving people the opportunity to express their views and take part in decisions on matters that affect them
  • responding to people’s personal preferences about their treatment and care, including communication and support needs
  • when people are not able to make a decision, those who have to decide for them take decisions based on the best interests of the person
  • maintaining confidentiality

Minimising the overall harm from the pandemic

Means:

  • cooperate to limit infection spread, especially to more vulnerable groups
  • minimise the risk of complications if someone is ill
  • avoid causing harm by inappropriately giving or omitting treatment or intervention
  • learn from experience both at home and abroad about the best way to provide optimal healthcare to people who are ill, and contribute to research to increase knowledge about it
  • minimise the disruption to society caused by the pandemic, including physical, psychological, social and economic harm
  • minimise the impact of the pandemic activity on other essential health services needed for people’s survival and wellbeing

Fairness

Means:

  • everyone matters equally, so people with an equal chance of benefiting from healthcare resources should have an equal chance of receiving them
  • ways of assessing potential benefits and harms from a health intervention or its timing must respect individual rights

Working together

Means:

  • healthcare services must work together with other services, statutory agencies and third sector, to plan for, and respond to, a pandemic
  • different parts of the overall health service must cooperate to help one another
  • citizens and health workers all take responsibility for their own behaviour, especially by not exposing others to risk
  • healthcare services being prepared to share information (for example, on the effects of treatment, or particular risks to some) that will help others

Reciprocity

Based on the concept of mutuality between healthcare users, workers giving care and institutions providing services, means:

  • any person asked to face increased risks or burdens during the pandemic should be supported on doing so by physical, mental and social wellbeing measures
  • service leaders should ensure that risks and burdens are minimised as far as possible for all, responding proportionately to the risk

Keeping things in proportion

Means:

  • those responsible for providing information will neither exaggerate nor minimise the situation and will give people the most accurate information that they can
  • those taking decisions on actions that may affect people’s daily lives, aiming to protect the public from harm, will act  flexibly and in proportion to the risks and benefits to individuals

Flexibility

Means:

  • those making individual healthcare plans will take into account new information and changing circumstances, and adapt plans accordingly
  • people will have as much chance as possible to express concerns about, or disagreement with, decisions about their healthcare that affect them
  • people who disagree with a decision about their health care are given access to a prompt, independent second opinion

Good decision-making

Means:

  • those making decisions about healthcare act with openness and transparency, in line with professional and legal responsibilities, and;
    • consult people as much as possible in the time available and provide adequate time for their decision making (with an advocate if wished), especially around end of life care and do not attempt Cardio-Pulmonary Resuscitation (DNACPR) decisions
    • involve people as much as possible in aspects of care planning that affect them, taking into account their individual needs and preferences
    • promote equity by assessing and responding to individual need, avoiding blanket policies based on protected characteristics especially disability or age
    • take into account all relevant views expressed and be open to challenge
    • be clear about what decisions need to be made, and the model of care or analysis being applied
    • be open about what decisions have been made, and why, and who is responsible for making them
    • try to ensure that no person or group is excluded from being involved in decision making that affects them
    • be accountable for the decisions taken or not taken
    • take decisions reasonably, rationally, based on evidence, with a clear, practical process
    • record decisions and actions along with the justification or reasons for them

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