Patient Autonomy in Crisis
Official statement by the Hans Albert Institute on the medico-ethical consequences of the corona pandemic
"Not the unconditional saving or prolongation of life should be the primary goal of medical action. Rather, the aim should be to provide medical care that corresponds to the will of the patients and contributes to their well-being." This is stated in a recommendation published today by the Hans Albert Institute (HAI), which deals with the medico-ethical consequences of the corona pandemic.
The Institute especially advises the elderly to "deal with the question of whether and how they would like to be treated in the event of an acute deterioration in their state of health". However, a "self-determined decision for or against a particular medical intervention requires knowledge of its chances of success as well as its risks. In the corona crisis, this concerns primarily the usefulness and adequacy of intensive medical treatment."
In this context, the Hans Albert Institute refers to empirical studies according to which only about 10 to 30 percent of patients survive invasive mechanical ventilation as a result of severe Covid-19 disease. Particularly in older patients, the chances of survival are described as "alarmingly low". Indeed, 97.2 percent of over-65 year-olds in New York who had received invasive mechanical ventilation died. Based on such findings, lung specialists now increasingly recommend reviewing current treatment practice. They suggest that, before switching to invasive ventilation, the full range of available noninvasive treatment methods should be exhausted in order to avoid further lung damage and possibly increase patients' chances of survival.
The case for a critical rational approach to medicine
In this regard, the Institute expressed explicit criticism of the German Society for Anaesthesiology and Intensive Care Medicine, which, when asked how high the percentage of patients who died after intubation is in Germany, stated that this was "entirely irrelevant, since it is not the intubation as such that is significant, but the severity of the patient's illness that led to the need for intubation and ventilation". The Hans Albert Institute objects that it is indeed crucial "to find out how many patients benefited from invasive mechanical ventilation and which factors had a bearing on this": "Only then can the usefulness of a therapy and thus its individual appropriateness be factually assessed. If it turns out that other treatment methods lead to better results, they should be preferred to invasive mechanical ventilation. On the other hand, not even considering an adjustment of the current course of action endangers the the patients' well-being."
The statement, authored by lawyers, physicians, and philosophers of the Hans Albert Institute, ends with the case for a "critical-rational medicine", which "continuously scrutinizes and improves its treatment practice". This requires not only "the ability to clearly state existing uncertainties in the current pandemic, but also the openness for alternative problem solutions": "After all, the strength of science lies above all in the willingness to learn from its mistakes."