How do doctors have to choose when not all patients can be helped in a pandemic? A federal law has now defined criteria for this. Not all doctors can understand them.
Offenbach/Frankfurt/Berlin (dpa/lhe) - A federal law on so-called triage is met with criticism from Hessian doctors. "I think the law is completely superfluous," said Stephan Sahm, medical ethicist and chief physician at Offenbach's Ketteler Hospital, the German Press Agency. The state medical association also reacted with "lack of understanding" and hopes that the law will be improved.
Why is? Last week, the Bundestag issued rules for so-called triage during a pandemic - as a supplement to the Infection Protection Act: According to the law, decisions should be made in the event of scarce capacities in intensive care units based primarily on the "current and short-term probability of survival" of a patient. Other criteria such as age or disability must not play a role.
The law still has to go through the Bundesrat. However, approval is not required. The reason was a decision by the Federal Constitutional Court in December 2021. Disabled associations had sued. The court ruled at the time that the state has a duty to protect people from discrimination because of their disability.
In intensive care units, even outside of pandemics, "painful but necessary" decisions have to be made again and again, said Sahm - for example when all the places are occupied and a new patient is added, or when wards have to be closed due to a lack of staff. "The medical profession has always dealt with it responsibly without there being any suspicion that certain groups of people are being disadvantaged. It is a mystery to me why this should not also work in a pandemic."
"Every medical treatment has to be checked again and again for its chances of success," said Sahm. If the chances of surviving were initially good, but have become "marginalized" afterwards, the treatment must be stopped. According to Sahm, the key criterion must be: How big are the chances that this person will ever leave the clinic upright? "When it comes to allocations of medical resources, all patients are equal."
So far, the so-called triage was not regulated by law, but only by recommendations. According to the State Medical Association, there is now a risk of "over-regulation". The law appears "hardly feasible in situations where quick decisions have to be made," said President Edgar Pinkowski. Under certain circumstances, up to three doctors would have to be consulted for the decision. "The concern about possible criminal consequences will make the medical decision even more difficult."
Sahm sees this danger less. For example, if a 70-year-old woman with a poor prognosis is separated from life-support machines in favor of a 17-year-old with a good prognosis, then formally that might be manslaughter. But he considers the chances that the doctor will be acquitted in the event of a trial to be very high. In general, he is "optimistic" that the law "does not cause much damage: we will continue to do well, I'm sure."
