Decisions on the allocation of intensive care resources in the context of the COVID-19 pandemic

Abstract

In view of the globally evolving coronavirus disease (COVID-19) pandemic, German hospitals rapidly expanded their intensive care capacities. However, it is possible that even with an optimal use of the increased resources, these will not suffice for all patients in need. Therefore, recommendations for the allocation of intensive care resources in the context of the COVID-19 pandemic have been developed by a multidisciplinary group of authors with the support of eight scientific medical societies. The recommendations for procedures and criteria for prioritisations in case of resource scarcity are based on scientific evidence, ethicolegal considerations and practical experience. Medical decisions must always be based on the need and the treatment preferences of the individual patient. In addition to this patient-centred approach, prioritisations in case of resource scarcity require a supraindividual perspective. In such situations, prioritisations should be based on the criterion of clinical prospect of success in order to minimize the number of preventable deaths due to resource scarcity and to avoid discrimination based on age, disabilities or social factors. The assessment of the clinical prospect of success should take into account the severity of the current illness, severe comorbidities and the patient’s general health status prior to the current illness.

COVID-19 im Alter – Die geriatrische Perspektive

“…Die CFS allein ist dabei für die Indikationsstellung für oder gegen eine intensivmedizinische Therapie unzureichend. In diesem Kontext kam es zu intensiven Diskussionen über die Zuteilung intensivmedizinischer Ressourcen im Zusammenhang mit der COVID-19-Pandemie [ 36 ]. Der aus der Katastrophenmedizin bekannte Begriff der Triagierung sollte im Zusammenhang mit der COVID-Pandemie aus ethisch-moralischer Sicht nicht benutzt werden.…”

Age, Frailty, Resuscitation and Intensive Care: With Reference to COVID-19

“…The basis of any treatment offered should be, following the principles of distributive justice and utilitarian principles, that access to health care should be on the basis of need and the person being offered or undergoing the treatment is going to gain an overall benefit. In other words, the benefit to be accrued from the treatment is greater than any harm that may occur and that no, or limited, harm will come to others [ 1 , 37 , 38 , 74 , 75 , 76 , 77 ].…”

“…Failure to do so may result in the death of the patient, even if that person is not dying, and not at the end of life. A contentious point in the UK is that the General Medical Council suggests that anyone is at the end of life at any time during their predicted last year of life [ 76 ]. However, CPR and MV are extraordinary treatments and therefore, would not necessarily need to be offered to all [ 74 , 75 ].…”

“…Who gets the offer of treatment? Should/can someone be taken off MV, if someone else is deemed to be more worthwhile, if they are not improving fast enough [ 15 , 75 , 76 , 80 ]? Inevitably, this suggests that there will be some inequality in provision which has the potential to be dependent on who is making the decision, who you are, and where you live.…”

“…Individual decisions cannot be made in a moral vacuum and inevitably, any choices affecting one person will inevitably affect others and some may inevitably come to harm, particularly when resources are limited [ 79 , 81 ]. Decision-making should be a collective approach, using the “multiple eyes principle” [ 76 ] and not leave one person exposed to any recrimination at a later date.…”