Tuesday, April 7, 2020

Ethics in times of the corona crisis: life or death? – Politics

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Intensive care physicians worldwide are preparing for an impending collapse of the clinics. If the number of people infected with the novel coronavirus Sars-CoV-2 continues to skyrocket, then, according to the great fear of the medical experts, at some point not all seriously ill patients can be treated in intensive care units. It’s not that far in Germany yet, but that could change.

In order to be prepared for this scenario, experts from seven medical societies have published instructions for action this Thursday to help doctors make the most difficult decision in their work. If ventilators, intensive care beds and staff really become scarce, they have to decide under time pressure which patients receive maximum intensive care therapy – and which help when dying.

In the paper now published, the authors emphasize that the age of the patient alone is not a criterion for selection. Rather, it is about the fundamental question of which patient has the greatest possible chance of surviving: Even in the event of a crisis, the aim is to meet the obligation to save as many lives as possible. Therefore, in the event of an overload, doctors should make the selection of the patients among all patients requiring intensive care – regardless of whether they are Covid 19 sufferers, stroke patients or accident victims, the authors write. They clearly reject prioritizing corona patients.

The recommendation for action has now created a common thread, so that everyone knows: “Even in the most difficult of all situations, decisions are not simply made based on gut feeling,” says Uwe Janssens, President of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI). It is shocking to see the pressure under which colleagues in other countries have to make decisions of this magnitude, says Janssens.

From Spain, for example, nurses report that people from the age of 75 with previous illnesses are given little chance of survival, which is why they do not even come to the intensive care unit.

Elderly care workers report that ambulances do not perform if it is determined that a sick person’s registration address is an old people’s home. To what extent the reports are correct and to what extent this is a mass phenomenon or individual cases cannot be determined at present.

Despite the drama in the north of Italy: so far the intensive care beds have been just enough

From the first phase of the crisis, there were reports from Italy that doctors had to decide who to connect to life-supporting devices and who not. Some of these reports were not verified, but circulated rapidly through social networks.

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Then the association of Italian anesthesiologists presented rules for “extraordinary conditions” in a document: Under point 3 it was said that in extreme cases a maximum age for admission to intensive care units could be necessary. But have there been any cases of triage so far? When asked recently by the head of national civil protection, Angelo Borrelli said he knew of none. For all the drama of the situation in the north of the country: the intensive care beds have so far just been enough. And now that the number of new infections is falling a little, one is confident that the race can be won.

The fact that the Italians themselves call the blue tents that they set up in front of the hospitals entrance a “pre-triage” also contributed to the confusion: What is meant is that the patients with Covid-19 are separated from others.

Israeli Prime Minister Benjamin Netanyahu issued a warning on Wednesday: “If the current rate of infection continues for another 15 days, we will be in a situation where we will have to decide who will connect to a ventilator and who will not.” In scenarios developed by scientists from the Hebrew University in Jerusalem on behalf of the government, 10,000 deaths are expected in one case and 25,000 deaths in the second. In the worst case, one million infected people are expected in the country with nine million inhabitants by the end of April.

According to the previous rules, every hospital and every doctor in Israel has to decide whether a patient is connected to a ventilator or not. According to Israeli media reports, in the event that the hospitals are faced with a large rush, age limits are discussed – that over 60-year-olds are then no longer connected to ventilators. Chances of survival could be another criterion. The Israeli Ministry of Health has so far not answered media inquiries as to whether a list of criteria is already being worked on.

Poland’s health minister is meanwhile trying to make room for expected Covid 19 patients – by postponing routine operations and delaying the treatment of even cancer patients. In circular 1203, the Ministry recommended hospitals to prescribe stable medication for cancer patients up to six months in advance, to send them home to patients, or to postpone visits. Hospitals that have been converted into one of 19 clinics designed exclusively for Covid 19 patients are said to refer cancer patients to other homes.

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