COVID-19 | Ethics

Introduction

The ongoing COVID-19 pandemic raises a number of important ethical questions, which may also emerge in the work of military health care personnel (HCP) as they are often part of the response to the pandemic. Therefore, the ICMM and its Center of Reference for Education on IHL and Ethics (RefC) in cooperation with the ZH Center for Military Medical Ethics (CMME) have decided to provide some guidance and resources on how to deal with the ethical issues.

On this page, we want to provide and continuously update a list of resources such as national ethics guidelines, important research, and other relevant documents that may inform and support HCP in their difficult decisions.

This page will be updated regularly. You can help us to keep this collection up to date by sending your input via email to This email address is being protected from spambots. You need JavaScript enabled to view it.


National and international medical ethics guidelines (alphabetical order)

Country/ Organisation
Issuing entity Title of the document
Link
[accessed]
Australia/ New Zealand Australian and New Zealand Intensive Care Society "Guiding principles for complex decision making during Pandemic COVID-19" Link (EN)
[06.10.2020]
Austria Österreichische Gesellschaft für Anästhesiologie, Reanimation und Intensivmedizin ÖARGI (ARGE Ethik) "ICU-Triage im Fall von Ressourcenmangel aus Anlass der SARS-CoV-2-Pandemie" Link (DE)
[31.03.2020]
  Österreichische Bioethikkommission "Zum Umgang mit knappen Ressourcen in der Gesundheitsversorgung im Kontext der Covid-19-Pandemie" Link (DE)
[08.04.2020]
Belgium Belgian Society of intensive care medicine "Ethical principles concerning proportionality of critical care during the COVID-19 pandemic: advice by the Belgian Society of IC medicine" Link (EN)
[31.03.2020]
Canada  Canadian Medical Association  "Framework for Ethical Decision Making During the Coronavirus Pandemic" Link (EN)
[06.10.2020]
Council fo Europe   "DH-BIO Statement on human rights considerations relevant to the COVID-19 pandemic" Link (EN)
[20.04.2020]
Germany Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI) "Entscheidungen über die Zuteilung von Ressourcen in der Notfall- und der Intensivmedizin im Kontext der COVID-19-Pandemie" Link (DE)
[01.04.2020]
  Deutscher Ethik-Rat "Solidarity and Responsibility During the Coronavirus Crisis" Link (DE/EN)
[01.04.2020]
  Bundesärztekammer "Orientierungshilfe der Bundesärztekammer zur Allokation medizinischer Ressourcen am Beispiel der SARS-CoV-2-Pandemie im Falle eines Kapazitätsmangels" Link (DE)
[06.05.2020]
Italy Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva SIAARTI "Raccomandazioni di etica clinica per l’ammissione a trattamenti intensivi e per la loro sospensione, in condizioni eccezionali di squilibrio tra necessità e risorse disponibili" Link (IT)
[01.04.2020]
Pan American Health Organization PAHO   "Ethics guidance on issues raised by the novel coronavirus disease (COVID-19) pandemic" Link (EN)
[01.04.2020]
Pakistan National Bioethics Committee, Pakistan "COVID-19 Pandemic: Guidelines for Ethical Healthcare Decision-Making in Pakistan" Link (EN)
[06.10.2020]
Society of Critical Care Medicine   "Society of Critical Care Medicine Crisis Standard of Care Recommendations for Triaging Critical Resources During the COVID-19 Pandemic" Link (EN)
[06.10.2020]
South Africa Critical Care Society of Southern Africa CCSSA "Allocation of Scarce Critical Care Resources During the COVID-19 Public Health Emergency in South Africa" Link (EN)
[06.10.2020]
Switzerland Swiss Academy for MEdical Sciences (SAMS) and Swiss Society for Intensive Care Medicine (SGI) "COVID-19 pandemic: triage for intensive-care treatment under resource scarcity."
Guidance on the application of Section 9.3 of the SAMS Guidelines «Intensive-care interventions» (2013)
Link (EN/FR/DE/IT)
[01.04.2020]
UNESCO UNESCO International Bioethics Committee (IBC) and
UNESCO World Commission on the Ethics of Scientific Knowledge and Technology (COMEST)
"Statement on COVID-19: ethical considerations from a global perspective" Link (EN/FR/ES)
[20.04.2020]
United Kingdom (UK) The National Institute for Health and Care Excellence (NICE) "COVID-19 rapid guideline: critical care in adults" Link (EN)
[06.10.2020]
Unites States (US) Expert Panel Report of the Task Force for Mass Critical Care and the American College of Chest Physicians "Triage of Scarce Critical Care Resources in COVID-19 An Implementation Guide for Regional Allocation" Link (EN)
[06.10.2020]
  British Medical Association (BMA) "COVID-19: ethical issues" Link (EN)
[06.10.2020]
World Health Organization WHO   "Managing Ethical Issues in Infectious Disease Outbreaks" Link (EN/FR)
[01.04.2020]
    "Ethics and COVID-19: resource allocation and priority-setting" Link (EN)
[10.08.2020]
World Medical Association WMA  

"WMA Declaration of Montevideo on Disaster Preparedness and Medical Response"

Link (EN)
[01.04.2020]

 

Selected readings in the ethics of triage

Not all listed items are with specific attention to COVID-19, but also more generally on triage.

  • Berlinger, N., Wynia, M., Powell, T., Hester, D., M., Milliken, and A., Fabi, R. 2020. Ethical Framework for Health Care Institutions Responding to Novel Coronavirus SARS-CoV-2 (COVID-19) Guidelines for Institutional Ethics Services Responding to COVID-19: Managing Uncertainty, Safeguarding Communities, Guiding Practice. The Hastings Center. https://www.thehastingscenter.org/wp-content/uploads/HastingsCenterCovidFramework2020.pdf
  • Christian, Michael D., Laura Hawryluck, Randy S. Wax, Tim Cook, Neil M. Lazar, Margaret S. Herridge, Matthew P. Muller, Douglas R. Gowans, Wendy Fortier, and Frederick M. Burkle. 2006.
    Development of a triage protocol for critical care during an influenza pandemic. Canadian Medical Association Journal 175: 1377. https://doi.org/10.1503/cmaj.060911
  • Emanuel, Ezekiel J., Govind Persad, Ross Upshur, Beatriz Thome, Michael Parker, Aaron Glickman, Cathy Zhang, Connor Boyle, Maxwell Smith, and James P. Phillips. 2020.
    Fair Allocation of Scarce Medical Resources in the Time of Covid-19. New England Journal of Medicine: NEJMsb2005114. https://doi.org/10.1056/NEJMsb2005114
  • Gostin, Lawrence O., Eric A. Friedman, and Sarah A. Wetter. 2020.
    Responding to COVID-19: How to Navigate a Public Health Emergency Legally and Ethically. Hastings Center Report. https://doi.org/10.1002/hast.1090
  • Howe, Edmund G. 2014. Medical Ethics in Disasters. In Conflict and Catastrophe Medicine: A Practical Guide, ed. James M. Ryan, Adriaan P. C. C. Hopperus Buma, Charles W. Beadling, Aroop Mozumder, David M. Nott, Norman M. Rich, Walter Henny, and David MacGarty, 91–110. London: Springer London. https://doi.org/10.1007/978-1-4471-2927-1_6
  • Iserson, Kenneth V., and John C. Moskop. 2007. Triage in medicine, part I: Concept, history, and types. Annals of emergency medicine 49: 275–281. https://doi.org/10.1016/j.annemergmed.2006.05.019
    Moskop, John C., and Kenneth V. Iserson. 2007. Triage in Medicine, Part II: Underlying Values and Principles. Annals of Emergency Medicine 49: 282–287. https://doi.org/10.1016/j.annemergmed.2006.07.012
  • Iserson, Kenneth. 2020. Healthcare Ethics During a Pandemic. Western Journal of Emergency Medicine 21. https://doi.org/10.5811/westjem.2020.4.47549.
  • Kramer, Jessica B., Douglas E. Brown, and Piroska K. Kopar. 2020. Ethics in the Time of Coronavirus: Recommendations in the COVID-19 Pandemic. Journal of the American College of Surgeons 230: 1114–1118. https://doi.org/10.1016/j.jamcollsurg.2020.04.004.
  • Levin, D., R. O. Cadigan, P. D. Biddinger, S. Condon, H. K. Koh, and Joint Massachusetts Dept Public Hl. 2009.
    Altered Standards of Care During an Influenza Pandemic: Identifying Ethical, Legal, and Practical Principles to Guide Decision Making. Disaster Medicine and Public Health Preparedness 3: S132–S140. https://dx.doi.org/10.1097%2FDmp.0b013e3181ac3dd2
  • Mannelli, Chiara. 2020. Whose life to save? Scarce resources allocation in the COVID-19 outbreak. Journal of Medical Ethics 46: 364–366. https://doi.org/10.1136/medethics-2020-106227.
  • Newdick C, Sheehan M, Dunn M. Tragic choices in intensive care during the COVID-19 pandemic: on fairness, consistency and community. Journal of Medical Ethics 2020; 46:646-651. https://jme.bmj.com/content/46/10/646
  • Persad, Govind, Alan Wertheimer, and Ezekiel J Emanuel. 2009. Principles for allocation of scarce medical interventions. The Lancet 373: 423–431. https://doi.org/10.1016/S0140-6736(09)60137-9
  • Winslow, G. R. 2003. Triage. Encyclopedia of Bioethics 5: 2520–2523.
  • Winsor, Shawn, Cécile Bensimon, Robert Sibbald, Kyle Anstey, Paula Chidwick, Kevin Coughlin, Peter Cox, et al. 2014. Identifying Prioritization Criteria to Supplement Critical Care Triage Protocols for the Allocation of Ventilators during a Pandemic Influenza. Healthcare Quarterly 17: 44–51. https://doi.org/10.12927/hcq.2014.23833

Research in ethics – collections

Research in medicine – collections

Other pages that may be helpful

Reports

Podcasts etc

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Disclaimer
  • This page does certainly not provide an extensive or complete list of possible references and guidelines. You can help us to keep it up to date by sending your input via email to This email address is being protected from spambots. You need JavaScript enabled to view it.
  • The ICMM, the RefC and the CMME do not necessarily subscribe to the views published in external documents.

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