What Triage Issues Reveal: Ethics in the COVID-19 Pandemic in Italy and France

End-of-Life Decisions in Intensive Care Units in Croatia—Pre COVID-19 Perspectives and Experiences From Nurses and Physicians

“…Among the most often noted issues faced within end-of-life decision-making, physicians and nurses express poor communication, role ambiguity, and the lack of clear guidelines (Deyaert, et al 2014 ; Latour, Fulbrook, and Albarran 2009 ; Wilkinson, Truog, and Savulescu 2016 ). This has recently been additionally complicated by the challenges that ICU physicians face during the COVID-19 pandemic (Orfali 2020 ; Anderson Shaw and Zar 2020 ).…”

The Ethical Unjustifications of COVID-19 Triage Committees

“…This paper argued against establishing separate triage committees responsible for allocating life-saving ventilators during pandemics. There are disparities within the ethics community on the manner and extent of ethicist involvement in pandemic triage guidance, as well as the adoption differences that vary across countries and cultures (Orfali 2020 ; Ehni, Wiesing, and Ranisch 2020 ; Jongepier 2020). This paper engaged with the procedural aspect of “who” shall make the allocation decisions and argued against the establishment of triage committees.…”

“…While the emerging consensus or, “gold standard,” for the ethics of triage is to create separate teams whose decisions on treatment allocation are independent from clinical staff, this paper argues that triage decisions should ultimately be made by clinicians who are guided by clear, regularly updated triage criteria that is adapted to resource availability (Feinstein et al 2020 ). While these independent triage committees are common strategies which U.S. hospitals employ to prepare for the pandemic, this trend has not been widely adopted in some European countries (Orfali 2020 ). Recommendations in some European countries and from some ethicists call for triaging and ventilator allocation under the clinician’s jurisdiction, guided solely by clinical judgement (Orfali 2020 ; Vergano et al 2020 ).…”

“…While these independent triage committees are common strategies which U.S. hospitals employ to prepare for the pandemic, this trend has not been widely adopted in some European countries (Orfali 2020 ). Recommendations in some European countries and from some ethicists call for triaging and ventilator allocation under the clinician’s jurisdiction, guided solely by clinical judgement (Orfali 2020 ; Vergano et al 2020 ). Ethics literature has outlined the intentions behind separating clinicians from triage decisions, which include minimizing moral distress, increasing objectivity and consistency, avoiding conflicts of goals, and increasing efficiency (Truog, Mitchell, and Daley 2020 ; Rosenbaum 2020 ; Feinstein et al 2020 ; Dunham, Rieder, and Hymbryd 2020 ; Emanuel et al 2020 ; Robert et al 2020 ).…”

Getting to the Truth: Ethics, Trust, and Triage in the United States versus Europe during the Covid‐19 Pandemic

“…Yet understanding how different societies allocate tragically scarce resources is crucial. 5 In this essay, I will compare discussions and guidelines around triage and the reality of triage decisions in the United States with what happened in Europe, both in anticipation of and during the pandemic. Why did the issue generate so many vivid and public ethical debates in the United States and relatively few in most European countries, even though the latter were also affected by the rationing of health care resources?…”