Without government guidance or PPE, doctors will have to make more unpopular choices about which lives to save

The government urgently needs to publish clear criteria so medics can carry out principled triage, writes David Lock and Vikram Sachdeva

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Even outside of pandemics, the NHS lawfully rations access to healthcare because there is a limit to the ability of the NHS to deliver a service to meet every clinical need. Parents seeking to conceive via IVF are well aware of these constraints, as are oncology patients who may be denied expensive life-extending drugs, or patients with rare diseases where the cost of treatment is prohibitive.

However, the NHS does not only grapple with financial constraints. The supply of donated organs never fully meets demand. Transplant surgeons quietly but efficiently operate prioritisation rules which govern who does and does not get access to scarce donated organs, with those denied invariably dying. The Court of Appeal recently decided those rules were lawful.

In these cases, doctors make decisions which result in potentially beneficial medical treatment being denied to patients. Why is the doctor who makes this decision not acting in breach of his or her duty of care to the patient? The answer is that doctors operate lawfully with a “menu” of options to treat a patient, but with some treatments deliberately kept off the menu because they are too expensive or for other reasons.