Triage in Germany: an expert explains the corona background and reveals the threats

Created: 12/28/2021, 3:25 PM

By: Patrick Freiwah

In view of the corona situation, clear regulations with regard to the threat of triage appear to be necessary.

Experts come to a clear judgment in the controversial debate.

Munich - The debate about a possible triage in German hospitals is ongoing - and in view of the pandemic, clear regulations are necessary.

When the capacities of hospitals or intensive care units reach their limits - and they have been doing so for some time - it is important that those responsible adhere to official guidelines.

This applies to situations in which fewer places or devices are available than are required for the patient.

As a result, doctors are faced with deciding which people will, for example, receive a ventilator and which will not.

There is currently no legal regulation for a feared triage situation: According to the relevant "recommendations" of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (Divi), the prospects of clinical success are the decisive criterion in such a situation.

Triage in hospitals: No disadvantage - neither for the disabled nor for those who oppose vaccinations

According to the decision of the Federal Constitutional Court published on Tuesday, the legislature must immediately take precautions to protect disabled people in the event of triage that is necessary due to the pandemic.

Otherwise there is a risk that people would be disadvantaged in the allocation of intensive care beds or equipment because of an existing disability.

The nine complainants are severely and in some cases severely disabled and mostly rely on assistance.

They fear a disadvantage in the corona pandemic if the hospitals are busy.

The reason: Because with certain disabilities or previous illnesses, the chances of success of intensive care treatment are worse than the average.

Connected to this debate is an idea that quite a few people are calling for citizens who oppose a corona vaccination: that in the event of a disease with Covid-19, this criterion is decisive, that in the case of triage, vaccinated people are given preference will.

To date, triage is only used in exceptional situations such as natural disasters, accidents or attacks with many victims.

In times when health care facilities have long been struggling with cost pressure and the need to save money, capacities in many places have reached their limits even without the scenarios mentioned.

In a recommendation published at the beginning of 2020, the German Ethics Council called for doctors not to be left alone with a possible triage decision: Rather, what is required is "largely uniform principles for action in clinical emergencies based on well-considered, well-founded and transparent criteria".

Coronavirus: Could vaccination affect the threat of triage in hospitals?

© Tobias Steinmaurer / Imago

Corona, triage and vaccination refusals: expert committees make a clear judgment

In 2021 it became clear how controversial this question is.

The ethics council and other committees discuss the prioritization of life-saving measures with politics, science and external experts.

The point seems extremely important, although the federal government has so far shied away from a clear regulation in terms of triage.

Recently, the German Association for Intensive Care and Emergency Medicine (Divi) felt compelled to update its guideline with regard to triage - due to the question of how to deal with vaccination refusals. In addition, the President of the Academy for Ethics in Medicine let it be known that precisely this situation should not be used. Georg Marckmann justified the guideline by stating that “for ethical reasons, claims to benefits in our solidarity-based health system are not made dependent on criteria such as 'self-fault' or 'personal responsibility'”.

As he describes, this inevitably leads to other groups of people having to be confronted with similar triage decisions.

In this context, those affected are named who, in view of an unhealthy or even risky lifestyle, also put their lives at risk - and thus also burden the health system: "This applies not only to obesity, smoking or risk sports, but also to the decision to forego one SARS-CoV-2 vaccination ", explained professional societies in this context.

Germany and the pandemic: Current recommendations for action in the event of a triage

What is the current practice with an impending triage in Germany?

Doctors can orientate themselves on recommendations for action, which expressly define clinical success as a criterion and not age or general physical condition.

In professional instructions it is said that intensive therapy is not indicated if the dying process has begun inexorably or if the therapy is hopeless because no improvement is to be expected.

Permanent corona alarm and anger at other groups of people: We live in a chronically stressed society.

An expert explains the background and possible solutions.