This editorial compares approaches in several European nations to triage of scarce critical care resources, such as ventilators. Specifically, it summarizes and contrasts provisions from plans adopted in Italy, Switzerland, Austria, Germany, the United Kingdom, and Belgium across a set of 10 key aspects.
Kay aspects assessed include:
- Issuing body
- Maximizing benefit
- Considering age/life span
- Additional criteria
- Patient will
- Termination of therapy
- Additional recommendations
- Identity/role of decision-maker.
The authors find that all plans concur that patients should be treated equitably according to the same criteria whether they have a COVID-19 diagnosis or another condition. Additionally, no guidelines favor a lottery or first-come, first-served approach as a general standard, and all instead prioritize on the basis of prognosis. However, there are key differences in how prognosis is to be assessed, with one of the most significant differences being consideration of only short-term survival or both short-term survival and long-term prognosis (including, in some cases, categorical exclusion based on age).
The authors also find general agreement among the reviewed plans with respect to the will of the patient (e.g., advance directives) guiding treatment choices and recognizing futility as a justification to end treatment. Plans also uniformly require regular reevaluation of decisions and call for psychosocial support for health professionals. All plans specify that triage decisions should be made fairly and transparently; most specify decision-making by interprofessional teams, while one requires a second opinion in cases of uncertainty. Preferential treatment for specific subgroups is avoided with the exception in some cases for health care staff.