Triage in the hospitals – “We ran into a completely avoidable situation” – News

The corona pandemic raises ethical questions. For example, who is being treated in an intensive care unit when space is scarce. The guidelines say that the decision will be based on the medical prognosis and the expected duration of treatment. Is that fair? The philosopher Adriano Mannino addressed the question.

Adriano Mannino

philosopher


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Adriano Mannino dealt with questions of triage in the book «Whom do I save – and if so, how many?», Which was published in spring 2021. Also in “Covid-19: What counts in the crisis” from 2020, he already dealt with the pandemic and the philosophical questions that arise from it.

SRF News: Are there fair criteria for triage?

Adriano Mannino: There is a certain consensus in the medical field. For example, the criterion of urgency, that of the success prognosis or the expected treatment effort. But in Germany disability associations have expressed concerns: Such criteria could have a discriminatory effect on people with disabilities and previous illnesses.

One hears more and more often the demand that the vaccination should also be decisive for the triage. A suitable criterion?

That is controversial. Many in the academic discourse think: No. I’m not so sure about that. It should be noted that the less controversial criteria – the prognosis of success and the expected treatment effort – correlate strongly with the vaccination status.

In practice, the vaccination status is perhaps not that important.

If someone is not vaccinated, it is likely that the prognosis will be worse and the effort will be greater. And that then automatically leads to a posteriorization of the unvaccinated. In other words, the vaccination status may not be that important in practice.

What speaks against it?

Counting the vaccination status as a criterion could mean a certain break in the system. Because usually we want to let the principle of solidarity prevail. We insure everyone in solidarity, and that in itself seems fair to me. Only it becomes more difficult when the solidarity of the vaccinated not only demands a financial contribution, but also demands it, depending on the case, even to die in a triage situation. There is also the polluter pays principle in criminal law. If, for example, you caused an emergency that was completely avoidable, then you must not simply free yourself from the emergency at the expense of a third party.

So if I go base jumping and have to go to the intensive care unit, would I have to wait in line because of this principle?

Usually not. If I don’t go base jumping but you do, and you are more likely to break something as a result, I would be more than happy to share your treatment costs in solidarity. That is my moral and maybe also legal duty.

If the solidarity of the vaccinated does not only require a financial contribution, but also sometimes even to die, it becomes more difficult.

But if you go base jumping in a situation in which you already know that there is a threat of overloading intensive medical resources, then you may force me into this triage situation through your actions. And then ethically and also legally the assessment of the situation changes.

Somebody has to make the decision who will be treated and who will not. What does that mean for the doctors?

For them this is an absolute borderline situation. It cannot be that in a constitutional state we can avoid – and I believe it was completely avoidable – run into a triage situation. For weeks we have had the soft triage, in which so-called elective operations are postponed, including bypass and cancer operations. People die too, fundamental rights are violated, to health care, to life. And doctors also have the right not to be forced into this situation as decision-makers if it would have been avoidable.

The interview was conducted by Christina Scheidegger.

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