[German "Triage Act"-Regulation with fatal consequences]

Area of Science:

• Medical Ethics
• Public Health Law
• Health Policy

Context:

• The recent implementation of Germany's Infection Protection Act (IfSG) § 5c, known as the Triage Act, marks a significant shift in crisis medical care allocation.
• This legislation has generated widespread dissatisfaction among medical professionals, legal experts, ethicists, and social associations.

Purpose:

• To analyze the implications of the Triage Act on medical resource allocation during crisis situations.
• To evaluate the Act's effectiveness in achieving the goal of maximizing patient benefit from medical care under resource constraints.

Summary:

• The Act explicitly prohibits discontinuing existing treatments to favor new patients with better prognoses (tertiary triage), resulting in a de facto "first come, first served" policy.
• This policy is criticized for potentially increasing mortality, particularly among vulnerable populations, and contradicts evidence-based prioritization criteria like age and frailty.
• The legislation's contradictory nature and inability to consistently implement allocation based on likelihood of success are highlighted, alongside the legal risks of deviating from standard care in crisis scenarios.

Impact:

• The Triage Act thwarts the objective of enabling the maximum number of patients to benefit from medical care during crises.
• It necessitates rigorous, legally compliant documentation, especially during decompensated crisis care.
• The law's restrictive approach may lead to suboptimal patient outcomes and ethical dilemmas in resource allocation.