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1.
Med Klin Intensivmed Notfmed ; 115(Suppl 3): 115-122, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1029344

ABSTRACT

In view of the globally evolving coronavirus disease (COVID-19) pandemic, German hospitals rapidly expanded their intensive care capacities. However, it is possible that even with an optimal use of the increased resources, these will not suffice for all patients in need. Therefore, recommendations for the allocation of intensive care resources in the context of the COVID-19 pandemic have been developed by a multidisciplinary group of authors with the support of eight scientific medical societies. The recommendations for procedures and criteria for prioritisations in case of resource scarcity are based on scientific evidence, ethicolegal considerations and practical experience. Medical decisions must always be based on the need and the treatment preferences of the individual patient. In addition to this patient-centred approach, prioritisations in case of resource scarcity require a supraindividual perspective. In such situations, prioritisations should be based on the criterion of clinical prospect of success in order to minimize the number of preventable deaths due to resource scarcity and to avoid discrimination based on age, disabilities or social factors. The assessment of the clinical prospect of success should take into account the severity of the current illness, severe comorbidities and the patient's general health status prior to the current illness.


Subject(s)
COVID-19 , Coronavirus , Critical Care , Humans , Methacrylates , Pandemics , Resource Allocation , SARS-CoV-2
2.
Ethics Inf Technol ; 23(3): 285-294, 2021.
Article in English | MEDLINE | ID: covidwho-891267

ABSTRACT

There is growing interest in contact tracing apps (CT apps) for pandemic management. It is crucial to consider ethical requirements before, while, and after implementing such apps. In this paper, we illustrate the complexity and multiplicity of the ethical considerations by presenting an ethical framework for a responsible design and implementation of CT apps. Using this framework as a starting point, we briefly highlight the interconnection of social and political contexts, available measures of pandemic management, and a multi-layer assessment of CT apps. We will discuss some trade-offs that arise from this perspective. We then suggest that public trust is of major importance for population uptake of contact tracing apps. Hasty, ill-prepared or badly communicated implementations of CT apps will likely undermine public trust, and as such, risk impeding general effectiveness.

3.
Dtsch Med Wochenschr ; 145(20): 1470-1475, 2020 Oct.
Article in German | MEDLINE | ID: covidwho-834945

ABSTRACT

Decisions about the initiation, continuation and termination of life-supporting treatments are a permanent challenge in intensive care units (ICUs). Decisions should be based on patient preferences and the medical indication. The medical indication is mainly the result of an assessment of the patient's prognosis and the applicable therapeutic options. Factors influencing the short term prognosis are mostly the severity of the acute leading disease, the number and severity of other organ failures and the response to initial treatment. Long term prognosis is dominated by the severity and number of comorbidities, age and the resulting frailty. Because in many patients all these informations are not available at the time of admission, in these cases a time-limited trial is often justified to gather all this information before a decision is made. These principles of decision making can also applied to situations in which ICU-capacities are limited (e. g. COVID-19 pandemic).


Subject(s)
Clinical Decision-Making , Critical Care , Betacoronavirus , COVID-19 , Coronavirus Infections , Humans , Intensive Care Units , Pandemics , Pneumonia, Viral , Prognosis , SARS-CoV-2
4.
Med Klin Intensivmed Notfmed ; 115(6): 477-485, 2020 Sep.
Article in German | MEDLINE | ID: covidwho-700035

ABSTRACT

In view of the globally evolving Coronavirus Disease (COVID-19) pandemic, German hospitals rapidly expanded their intensive care capacities. However, it is possible that even with an optimal use of the increased resources, these will not suffice for all patients in need. Therefore, recommendations for the allocation of intensive care resources in the context of the COVID-19 pandemic have been developed by a multidisciplinary authors group with support of eight scientific medical societies. The recommendations for procedures and criteria for prioritisations in case of resource scarcity are based on scientific evidence, ethico-legal considerations and practical experience. Medical decisions must always be based on the need and the treatment preferences of the individual patient. In addition to this patient-centred approach, prioritisations in case of resource scarcity require a supra-individual perspective. In such situations, prioritisations should be based on the criterion of clinical prospect of success in order to minimize the number of preventable deaths due to resource scarcity and to avoid discrimination based on age, disabilities or social factors. Assessment of the clinical prospect of success should take into account the severity of the current illness, severe comorbidities and the patient's general health status prior to the current illness.


Subject(s)
Coronavirus Infections/epidemiology , Critical Care/ethics , Health Care Rationing/ethics , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , Clinical Decision-Making , Humans , Pandemics/ethics , Practice Guidelines as Topic , SARS-CoV-2 , Societies, Medical
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