When preparing for the worst might be even worse - uncovering the dynamics of silent triage in Switzerland during the Corona pandemic

Krones, Tanja; Schüpbach, Reto; Monteverde, Settimio (22 July 2022). When preparing for the worst might be even worse - uncovering the dynamics of silent triage in Switzerland during the Corona pandemic In: World Congress of Bioethics. Basel. 22.-24.07.2022.

In the face of the threatening increase of patients needing Intensive care unit support during the Covid-19 pandemic waves, most Swiss hospitals, fostered by Swiss Cantonal health authorities and the state, have mandated a concentration of ICU-resources in the face of imminent scarcity. In parallel, hospitals maximized both reserve capacities and coordination efforts to increase the effectiveness of ICU resources use while demanding the stop of elective surgery in parallel. thus try to prevent an explicit triage. These measures were concordant both with the ethical guidelines of the Swiss Academy of Medical Sciences on triage and other professional bodies. Yet, officially, a triage situation has never taken place while scarcity of resources, lower quality of care, shift of indications and excess mortality became obvious in the second COVID wave in Switzerland, flanked by efforts of different Cantons to “avoid” an overloading of the ICU by imposing gatekeeping mechanisms (e.g., restricted access to hospital for people living in nursing homes, deferral of “non-essential” treatment, deferral of extra-cantonal patients). Methods Departing from our clinical ethical experiences and available data in Switzerland and other European countries, we reflect on the concept of a “silent triage” as an implicit rationing instead of applying transparent, explicit triage criteria as explicit rationing to save as many lives as possible in in a non-discriminatory way. Conclusion The recent history of (not) applying ethically founded and consented triage criteria sheds light on the foundational debate on and mechanisms of explicit versus implicit rationing. A more comprehensive concept of triage might be needed encompassing all the possible implications and opportunity costs of triaging at the “sharp end” of ICU and making the precedents of ICU triage “at the blunt end” accessible to overt discussion and ethical debate.

Item Type:

Conference or Workshop Item (Speech)


School of Health Professions
School of Health Professions > Nursing


Krones, Tanja;
Schüpbach, Reto and
Monteverde, Settimio0000-0002-7041-2663


B Philosophy. Psychology. Religion > BJ Ethics
R Medicine > R Medicine (General)
R Medicine > RT Nursing




Settimio Monteverde

Date Deposited:

02 Aug 2022 15:57

Last Modified:

02 Aug 2022 15:57

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