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.
National and international medical ethics guidelines (alphabetical order)
||Issuing entity||Title of the document
|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)
|Österreichische Bioethikkommission||"Zum Umgang mit knappen Ressourcen in der Gesundheitsversorgung im Kontext der Covid-19-Pandemie"||Link (DE)
|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)
|Council fo Europe||"DH-BIO Statement on human rights considerations relevant to the COVID-19 pandemic"||Link (EN)
|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)
|Deutscher Ethik-Rat||"Solidarity and Responsibility During the Coronavirus Crisis"||Link (DE/EN)
|Bundesärztekammer||"Orientierungshilfe der Bundesärztekammer zur Allokation medizinischer Ressourcen am Beispiel der SARS-CoV-2-Pandemie im Falle eines Kapazitätsmangels"||Link (DE)
|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)
|Pan American Health Organization PAHO||"Ethics guidance on issues raised by the novel coronavirus disease (COVID-19) pandemic"||Link (EN)
|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)
|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)
|World Health Organization WHO||Managing Ethical Issues in Infectious Disease Outbreaks||Link (EN/FR)
|World Medical Association WMA||
WMA Declaration of Montevideo on Disaster Preparedness and Medical Response
Selected readings in the ethics of triage
- 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
- 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
- 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
- AMA Journal of Ethics, Resources on COVID-19
- The Hastings Center – Ethics Resources on the Coronavirus (COVID-19)
- Johns Hopkins University – Coronavirus Resource Center.
- A Philosophy & COVID-19 Bibliography
Research in medicine – collections
Other pages that you may find helpful
- The ICMM's COVID-19 page – http://www.cimm-icmm.org/covid-19/
- The COVID-19 Humanitarian site by a number of organizations – https://www.covid19humanitarian.com/
- The Global Philospher (BBC) – Pandemic Ethics
- ICRC Humanitarian Las & Policy Blog – From the ‘Spanish Flu’ to COVID-19: lessons from the 1918 pandemic and First World War
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- The ICMM, the RefC and the CMME do not necessarily subscribe to the views published in external documents.