There is praise for the triage recommendations of the specialist societies - but there is still some open question when it comes to which seriously ill people are helped in case of doubt and which are not.
- Corona pandemic *: Experts provide recommendations for triage
- Dealing with the seriously ill in overloaded intensive care units is discussed
- Vienna theologian Ulrich Körtner: "You need measures that are only known from disaster and war medicine"
It should be every doctor's nightmare: in an extreme situation, having to decide which patients, which patients should be treated and which should not - and therefore have to die with some probability. A conflict of enormous ethical and moral dimensions that one can hardly imagine.
The "German Interdisciplinary Association for Intensive Care and Emergency Medicine" (Divi) has therefore published a catalog of criteria that doctors can use if the resources in emergency rooms and intensive care units are no longer sufficient during the Covid 19 pandemic and they are seriously ill have to make a selection; Triage is the technical term for this, which medical laypersons have known since Corona . There are seven medical societies behind the divi, including the Academy for Ethics in Medicine.
Responsibility in the corona crisis: chances of recovery should decide
Now the German Ethics Council has also presented "ad hoc recommendations" on "Solidarity and Responsibility in the Corona Crisis". It emphasizes the priority of politics right from the start. "Scientific advice" is important, but cannot and should not replace it. "The corona crisis is the hour of democratically legitimized politics," is the final sentence of the publication. Dealing with the very seriously ill in overloaded intensive care units is also addressed in the paper of the German Ethics Council. "Triage situations" should be avoided. And it must be ensured that decisions are made regardless of social status, origin, age or disability.
The “clinical-ethical recommendations” of the seven specialist societies also provide for this. In this way, the scientists emphasize that "prioritization" is "not permitted" due to "social criteria" or age. This is particularly important in view of the fact that some seriously ill Covid 19 patients over 80 were no longer treated in Italian hospitals, which is covered by the guidelines there.
According to the German recommendations, only medical aspects should be the decisive factor
Employees of the German Institute for Disaster Medicine in Tübingen report similar things from Alsace. The scientists visited the Strasbourg University Clinic on Monday. They report conditions similar to those in Italy that force doctors to choose. The criterion here is age: Anyone who has exceeded 80 will no longer be ventilated. According to the scientists from Tübingen, this approach should be carried out by the French ethics committee. However, the Strasbourg University Hospital denied that age was the only criterion.
According to the German recommendations, only medical considerations should decide which patients are to be treated in intensive care medicine - whereby the chances of success of a therapy are the decisive criterion. Experts rate the content of the specialist societies' paper positively, but they also say that it was "overdue", such as Robert Ranisch from the International Center for Ethics in Science and the Institute for Ethics and History and Medicine at the University of Tübingen, and Ulrich Körtner, board member of the Institute for Ethics and Law in Medicine at the University of Vienna. Neighboring countries such as Austria and Switzerland were earlier with their criteria.
Corona pandemic: special guidelines for general practitioners
The German recommendations are "sufficiently extensive", a great help in everyday clinical practice and ensure that "decisions can be made in a way that is comprehensible, transparent and ethically justifiable", praises Nils Hoppe, Professor of Ethics and Law in the Life Sciences at Leibniz University Hanover, the suggestions.
However, he is critical of the recommendation that the triage should “take place as early as possible”. “Under certain circumstances, this means a decision by general practitioners. This would undermine the important requirement of an interdisciplinary consensus decision, as is possible in a clinical context, ”says the scientist. He therefore suggests that "special recommendations for general practitioners" should be considered. Hoppe also points out that age can become a criterion indirectly - because with Covid-19 "a correlation of age and other underlying diseases extremely often impair the chances of success of the treatment".
The Viennese theologian Ulrich Körtner emphasizes that the topic of triage should not only be discussed "behind the scenes" - that is, in specialist circles and in politics. "The population should know: The situation is actually so serious that you already need a plan B, namely measures that are only known from disaster and war medicine."
Robert Ranisch also thinks it is important to have an open discussion about the criteria catalog of the German professional associations. "This may be difficult, but it is necessary." You have to be careful about "moralization", says the managing director of the Clinical Ethics Committee at the University Hospital Tübingen. For "dilemma situations" there are "no ideal and certainly no easy answers".
In a further step, the recommendations would then have to be "provided with the necessary commitment", Ranisch warns. So far, the catalog of the professional associations has only been a proposal without a "binding effect for health care facilities".
And the Tübingen ethicist addresses another aspect: With regard to the staff in clinics, care must be taken "for possible relief measures such as debriefings or psychological care". Because the burden on these people is "hard to overestimate".
By Pamela Dörhöfer and Stefan Brändle
* fr.de is part of the Ippen-Digital editors network