CYIL vol. 12 (2021)

petr šustek CYIL 12 (2021) the particular situation, even if they led to the denial of life-saving intensive care to a patient who would be treated under normal circumstances. In extreme cases, it might be necessary to introduce a specific strict age criterion (which is not specified in the recommendations). One month later, the Italian Committee for Bioethics (CNB) issued its own document called “Covid-19: Clinical Decision Making In Conditions of Resource Shortage and the ‘Pandemic Emergency Triage’ Criterion”. 47 According to the CNB, the only permissible prioritisation criterion is the clinical appropriateness of care for a particular patient. All other possible criteria including age are considered ethically unacceptable. Unlike the above-mentioned documents, the Swiss guidelines called “Covid-19 Pandemic: Triage for Intensive Care Treatment Under Resource Scarcity” 48 (“Intensive care triage under exceptional resource scarcity” under the latest update from September 2021 49 ) are very detailed and specific. According to the Swiss Academy of Medical Sciences (SAMW) which issued the document, the primary criterion is a short-term prognosis (regarding hospital discharge). Criteria like lottery, first come, first served , or “social usefulness” of the patient are explicitly abandoned. Nevertheless, the document sets a refined system of particular medical criteria for intensive care including several contraindications (such as comorbidities or general frailty). Age can be considered in relation to other criteria which influence the patient’s short-term prognosis. There are defined age limits which in combination with other particular criteria exclude patients from access to intensive care. Overall, the SAMW guidelines are relatively strict and potentially excluding defined groups of patients. The German guidelines issued by eight professional societies under the name “Decisions on the Allocation of Intensive Care Resources in the Context of the COVID-19 Pandemic” 50 do not contain any strict contraindication which would automatically mean the patient will not be admitted to the intensive care unit. Nevertheless, several health conditions are identified which indicate a worse likelihood of the good outcome of care. The German guidelines explicitly admit that “ [a]s there are currently no specific legal regulations in Germany, the decision- makers bear the responsibility for these decisions ”. One of the reasons for this uncertainty lies in 47 See Comitato nazionale per la bioetica. Covid 19: la decisione clinica in condizioni di carenza di risorse e il criterio del “triage in emergenza pandemica”. (8 April 2020.) accessed 11 June 2021. English version under the name “Covid 19: clinical decision-making in conditions of resource shortage and the “pandemic emergency triage” criterion” is available at: . 48 See Swiss Academy of Medical Sciences. Covid-19 pandemic: triage for intensive-care treatment under resource scarcity. Revised version 3.1 . (17 December 2020.) accessed 11 June 2021. 49 See Swiss Academy of Medical Sciences. Intensive care triage under exceptional resource scarcity. Revised version 4 . (23 September 2021.) accessed 04 November 2021. 50 See MARCKMANN, Georg, NEITZKE, Gerald, SCHILDMANN, Jan, MICHALSEN, Andrej, DUTZMANN, Jochen, HARTOG, Christiane, JÖBGES, Susanne, KNOCHEL, Kathrin, MICHELS, Guido, PIN, Martin, RIESSEN, Reimer, ROGGE, Annette, TAUPITZ, Jochen, JANSSENS, Uwe. Entscheidungen über die Zuteilung intensivmedizinischer Ressourcen im Kontext der COVID-19 Pandemie. Medizinische Klinik – Intensivmedizin und Notfallmedizin. (2020, Vol. 115, Issue 6), pp. 477–485. doi: https://doi.org/10.1007/ s00063-020-00708-w, accessed 11 June 2021. English version under the name „Decisions on the allocation of intensive care resources in the context of the COVID-19 pandemic” is available at: https://doi.org/10.1007/s00063- 020-00709-9.

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