Political clarification is needed: triage between vaccinated and unvaccinated?

Political clarification is needed
Triage between vaccinated and unvaccinated?

Patient vaccinated or not – should that play a role in overloaded intensive care units? Medical ethicists have quite different views on this. The demand for political clarification comes from a medical ethicist.

Last winter, various clinics were forced to triage, i.e. to decide which corona patient to help first due to scarce resources. In the meantime, individual hospitals have had to switch to this again. In view of the increasing overloading of intensive care units by corona patients, the Bonn medical ethicist Annette Duffner has therefore suggested a political clarification of the question of whether vaccinated patients should be given preference over unvaccinated patients during triage. “The bottom line is that I believe that observing the vaccination status in an overcrowded intensive care unit could be argued,” said the Bonn professor at the “Rheinische Post”.

The choice of patients depends on the one hand on how broadly the principle of solidarity is to be understood. On the other hand, it is about how the motivation of people who do not get vaccinated should be assessed. Alcoholics will not be deprived of a transplant liver because of its addictive nature. It should be asked, however, whether the fear of vaccine damage has a similar character or not. “Ultimately, such decisions should be made politically,” explained the medical ethicist.

The Bochum medical ethicist Jochen Vollmann took the view that the vaccination status was “not a decision criterion for the allocation of limited resources in the health care system”. With the same urgency, the decisive factor from a medical ethical point of view is which patient in an acute emergency situation intensive medical treatment would help most. “Such a situation will always remain an ethical dilemma,” explained the Bochum professor.

Hospitalization rate increases

On Friday, the number of corona intensive care patients by the German Interdisciplinary Association for Intensive and Emergency Medicine (Divi) was given as 2851, while the number of available intensive care beds fell to 2478. The Robert Koch Institute named a further increase in hospitalization rate of 4.70 on Friday . The value indicates how many corona patients per 100,000 inhabitants with serious illnesses are admitted to hospitals within a week. In Thuringia and Saxony, the value is significantly higher and is approaching the national highs of the end of December 2020, when it was almost 16.

On Thursday, doctors in Munich warned of a collapse of the hospitals in the Bavarian capital. Axel Fischer, managing director of the Munich Clinic Schwabing, spoke of an “emergency” of the clinics due to the critical corona situation. You are currently in control of the pandemic, said Fischer in Munich – but only “because 50 percent of our predictable operations and interventions have already been shut down”. The point of triage, i.e. the prioritization of medical emergencies due to lack of resources, can be reached “within a few weeks”, “if countermeasures are not taken now”. The physician named the more aggressive behavior of the Delta variant, a decrease in immunization “especially” among those vaccinated at the beginning of the year and a too low vaccination rate in the general population as reasons for this.

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