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How to make life-or-death decisions

March 26, 2020

The COVID-19 pandemic could lead to an acute shortage of intensive care beds in hospitals around the world. German doctors have now come up with guidelines on how to prioritize treatment.

ICU in Brescia hospital in Italy
Image: picture-alliance/dpa/AP/LaPresse/C. Furlan

German doctors' associations have agreed on a set of ethical guidelines to help doctors make life-or-death decisions when treating coronavirus patients.

"Should we get into the difficult situation where we have to choose between patients, then we want to be prepared," Uwe Janssens, president of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), said at a press conference in Berlin on Thursday.

The COVID-19 pandemic has left health systems in many countries simply unable to cope with vast numbers of patients needing intensive care beds and ventilation. 

In Italy and Spain, that's forced overburdened doctors with limited resources to decide which critically ill patients should get treatment, and which should not. Experts predict that medical workers in Germany will soon find themselves in a similar situation. 

Who gets priority?

Janssens stressed that decisions about who gets treatment must be medically justified and fair. Transparency and earning the trust of the population are crucial, he told reporters.

Read more: Coronavirus and ethics: 'Act so that most people survive'

Under the new coronavirus recommendations, which have been adopted by seven German medical associations, a patient's chances of surviving intensive care treatment should be the main factor guiding doctors' actions. A team of three experts with different medical backgrounds should make the final life or death decision, according to the paper.

The severity of the coronavirus infection, secondary illnesses, and the patient's will should all be considered, the document says, but age and social status should not come into play. 

Age not among criteria

"We have very clearly decided against 'age' as a criterion and want to proceed in a very nuanced way," Janssens said. 

The document specifies that priority should not be given in cases where the dying process has already begun or if the only chance of survival is a permanent stay in the ICU.

The document acknowledges that these decisions pose "enormous emotional and moral challenges for the treatment team," but adds that having clear guidelines for how to act could save stress in the end, while at the same time strengthen hospitals' crisis management capabilities.

nm/ng (dpa, KNA, epd)

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