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Institute of Biomedical Ethics and History of Medicine (IBME)

Ethics guidelines on COVID-19 triage - an emerging international consensus

Susanne Joebges and Nikola Biller-Andorno published in "Critical Care" a paper reviewing international guidelines on the triage of COVID-19 patients.



COVID-19—classified as a pandemic by the WHO on March 11, 2020—is expected to put tremendous strain on many healthcare systems. Early epidemiological analyses show that compared to the seasonal flu, COVID-19 patients may require ventilation much more frequently. This can lead to a shortage of ventilators and intensive care resources, resulting in limited medical care and death. Whereas some countries have been exposed very early, others had the opportunity to prepare for the ethical challenges that emerge when intensive care resources become scarce.

In everyday medical practice, ventilation may be withheld or withdrawn if it is not or no longer indicated or against a patient’s will. In crisis situations, such as pandemics, this practice is superimposed by an additional triaging process. Medical factors of triage recommendations typically contain exclusion criteria, a mortality assessment (e.g., Sequential Organ Failure Assessment (SOFA) score), and a re-evaluation requirement. Beyond the medical aspects, however, triaging unavoidably involves moral choices. The main ethical considerations for making such choices concern equity and maximizing benefits. Other criteria such as considering life stages, rewarding prosocial behavior, or giving priority to the worst off have been subject to long-standing controversy.


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