New triage law: After criticism from the Greens – Lauterbach does not want to allow “ex-post” triage

Germany The “duty to protect” recalled

After criticism of the Greens – Lauterbach does not want to allow “ex-post” sorting

Karl Lauterbach (SPD), on the sidelines of the federal government's closed session at Schloss Meseberg

Karl Lauterbach (SPD), on the sidelines of the federal government’s closed session at Schloss Meseberg

Source: dpa

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Should one patient’s medical treatment be interrupted in favor of another with a better chance of survival? Health Minister Lauterbach (SPD) is to regulate the matter by law. Critics have called for better protection for people with disabilities.

BHealth Minister Karl Lauterbach (SPD), contrary to rumours, does not want a triage regulation that would allow intensive care in the hospital to be discontinued in favor of a patient with a better chance of survival.

This “ex post triage is ethically unacceptable,” Lauterbach said Monday in Berlin. Neither doctors, nor patients, nor relatives should be required to do so. “That’s why we won’t allow it either.” And even triage before treatment should only be possible under strict conditions, Lauterbach added. Due to last year’s Constitutional Court ruling on triage, “however, we need to illuminate the gray area of ​​medical decisions in the pandemic,” Lauterbach said. “We will shortly present a corresponding bill.”

“Triage decisions were a real danger in this pandemic in Germany, but were never part of everyday life,” Lauterbach pointed out. The corona measures and the patient transfers made it possible to take good care of all the sick. “It should stay that way in the future.”

Headwind to the first bills

According to reports, a bill from the Ministry of Health initially provided that intensive care could be withdrawn in favor of a patient with a better chance of survival if three doctors agreed.

However, the Greens protested against this project. “With this law, the state would not fulfill its special duty to protect,” said Corinna Rüffer, MP. “People with disabilities would always run the risk of being excluded from intensive care because of their disability,” Rüffer told the RND editorial network. “It would mean that seriously ill people would have to live in hospital with the constant fear that medically necessary life support measures would be withdrawn in favor of someone else.”

The Patient Protection Foundation had also criticized an early triage bill. “The mandate of the Federal Constitutional Court to better protect people with disabilities in triage decisions is in no way fulfilled by transferring the decision to three private persons,” said the board of directors of the Foundation for the protection of patients, Brysch, of the AFP news agency with in view of the decision envisaged by three doctors. “Three times subjective doesn’t even become objective.” The legislator must set specific guidelines and criteria according to which such decisions are made. “Cuckling here is going to lead to a tough ethical battle.”

Critics also came from Caritas. The discussion would gradually evolve “from an instrument of medical assessment in acute emergency situations to a legitimization of the rationing of medical services based on usefulness and quality of life”, explained the president of the Catholic social welfare association, Eva Maria Welskop-Deffaa.

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To die

The Constitutional Court had asked for a new regulation

At the end of last year, the Federal Constitutional Court requested a triage law. If capacities are scarce in the event of a pandemic, it should be possible in the future to interrupt intensive care in favor of a patient with a better chance of survival. The draft sorting regulations are still being coordinated by the departments. The passage of the law that regulates so-called ex-post triage has been and is particularly controversial.

It is much more delicate than ex-ante triage, which consists of deciding which patient will or will not receive treatment in the event of a shortage linked to the pandemic. According to the bill, “ex post triage” should only be allowed if three specialists with experience in intensive care medicine make the decision by mutual agreement.

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26 March 2020, Berlin: A dummy doll lies on a bed in the newly opened intensive care unit of the Vivantes Humboldt-Klinikum in the Reinickendorf district on a Dräger ventilator.  The clinic now has 37 new beds in the intensive care unit for possible Covid 19 patients. Photo: Kay Nietfeld/dpa +++ dpa photo radio +++

The term triage comes from war medicine and is often used as a synonym for the term observation. Sorting first came to prominence during the Napoleonic Wars of the 18th century. The name comes from French and means something like read, select or sort.

Today, triage is used in disaster medicine, but also in intensive care medicine. Doctors use them in a so-called mass casualty incident. Patients are triaged according to urgency and severity of illness or injury. In simple terms, they are divided into three groups: people who do not need treatment, patients who no longer need treatment because they are about to die, and patients who need care. medical and who also benefit from them.

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