Triage as the ultimate challenge for the individual, for society
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Triage as the ultimate challenge for the individual, for society
Germany could soon experience something unprecedented in the history of the Federal Republic of Germany: if intensive care units were overloaded, doctors would in the worst case have to decide who should be allowed to live and who should die. Rescue forces know this from exercises or missions abroad as »triage« (French for sorting, selecting, choosing) or »triage«. This prioritisation is thus an ethically extremely challenging task, because decisions have to be made that very likely mean the death of some of those affected. But how does our society deal with this issue? »If intensive care treatment were actually still medically necessary, this would be an actively lethal act from a strictly legal point of view,« explains legal philosopher Reinhard Merkel, member of the German Ethics Council (dpa, 06.04.2020).
And thus there would not only be an existentially felt guilt in the death of people, but also a legally actionable one. The aforementioned Ethics Council comments on this in its publication »Solidarity and Responsibility in the Corona Crisis«: in such a case, the doctor could »count on an apologetic leniency of the legal system« (ethikrat.org, 27.03.2020). Merkel again commented: »There is no such thing as a morally guilt‐free decision in such a situation. But doctors must be protected as best they can from criminal law in such a dramatic situation.« The discussion intensifies at this point on the basis of the question of whether human lives can be set off against each other (»old« lives versus »young« lives, etc.). The German constitution makes it clear that »human life and human dignity enjoy equal constitutional protection without regard to the duration of the physical existence of the individual human being« (Bundesverfassungsgericht, 2006).
Thus, the ethical consideration in Germany stands against the moral philosophy of utilitarianism (the collective good should be maximised, the maximum possible happiness for the largest possible number of people), as it is practised in many other countries. This is currently the case in the selection of covid‐19 patients in Italy, among others: here, maximising the expected lifespan of the patients is the criterion for care on the part of the medical staff. The practice of logotherapy and existential analysis contrasts and, already with Frankl, resolutely opposes utilitarianism, with reference to the importance of the individual in his or her specific dignity. The solution in the dilemma of triage in the case of »an overload of intensive care units would be to decide by lot in order to guarantee absolute equality of opportunity« (dpa, 06.04.2020). Here, too, the decision‐makers concerned do not escape their existential guilt; on the contrary: for those involved and especially the »final decision‐makers«, there are often feelings of guilt or post‐traumatic stress disorders on a personal level as a consequence. In Germany, therefore, the decision on life and death must always be made by the team, if possible. Ultimately, however, the individual is left alone with the question of how to deal with it.
