As intensive care measures can be very stressful for all concerned, the SAMS in 2013 issued medical-ethical guidelines on «Intensive-care interventions» to support health professionals. Since 2020, the coronavirus (SARS-CoV-2) has created additional challenges for intensive care units (ICUs). Therefore, the SAMS prepared an annex on triage decisions under exceptional resource scarcity, supplementing the 2013 guidelines. The document has been updated several times and is meanwhile less strongly focused on Covid-19 patients.
As long as sufficient (human and material) resources are available, all patients requiring intensive care are admitted and treated according to established criteria. If an emergency arises in which large numbers of severely ill patients require ICU treatment – for example, during a pandemic or due to a natural hazard – rationing decisions will be necessary, placing considerable burdens on medical staff. This makes it all the more important that uniform criteria for ICU admission and continued occupancy should be applied throughout Switzerland.
The overarching goal is to ensure that, even under exceptional resource scarcity, as many lives as possible can be saved with the resources available, irrespective of the disease or injury leading to hospitalisation.
The updated guidelines (V4) are now available in French and German. English and Italian versions will also be available from next week (27 to 30 September); information on this will be provided in a brief newsletter.
You can find all the medical-ethical guidelines published by the SAMS in the Publications menu.
FAQs for interested members of the public
Since the «Triage guidelines» were first issued in March 2020, they have received attention well beyond the original target group and in some cases have given rise to broad media coverage. Therefore, our website with FAQs puts the widely discussed criteria into context and explains their background both for interested members of the public and for journalists; the list of questions is being continuously updated.
In the spring of 2020, at the start of the Covid-19 pandemic, the SAMS, together with the Swiss Society of Intensive Care Medicine (SSICM), prepared guidelines for intensive care triage under exceptional resource scarcity offering practical guidance for decision-making. The guidelines were first published on 20 March 2020. They will be continuously adapted if experience in practice or new scientific findings so require. On this page, you can find the latest version. All previous versions can be found here.
SAMS Newsletter on the subject
For each version of the guidelines, the SAMS has published a Newsletter (German or French), highlighting the most important content or changes. The summaries of these Newsletters in English can be found on the chronology page.
A large ethical debate and public survey
ethix, Lab for Innovation Ethics, has also helped to broaden the debate on triage decisions. In a blog post (German/French), you can find a document presenting the key elements of the guidelines (Versions 1 and 2) as well as a questionnaire that submits various triage scenarios for discussion.
International comparison of guidelines
Recommendations on Covid-19 triage: international comparison and ethical analysis (Bioethics, 25 September 2020)
Ethics guidelines on Covid-19 triage – an emerging international consensus (Universität Zürich, May 2020)