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Pandemic ICU triage challenge and medical ethics
  1. Sabine Netters1,
  2. Nick Dekker1,
  3. Koos van de Wetering2,
  4. Annie Hasker3,
  5. Dian Paasman4,
  6. Jan Willem de Groot1 and
  7. Kris C P Vissers5
  1. 1 Oncology Centre and Internal Medicine Department, Isala, Zwolle, The Netherlands
  2. 2 Intensive Care Department, Isala, Zwolle, The Netherlands
  3. 3 Pastoral Care Department, Isala, Zwolle, The Netherlands
  4. 4 Internal Medicine Department, Isala, Zwolle, The Netherlands
  5. 5 Anaesthesiology Department, Radboud University Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Sabine Netters, Oncology Centre and Internal Medicine Dept, Isala, Zwolle 8000 GK, The Netherlands; f.j.s.netters{at}


The COVID-19 pandemic has made unprecedented global demands on healthcare in general and especially the intensive care unit (ICU). the virus is spreading out of control. To this day, there is no clear, published directive for doctors regarding the allocation of ICU beds in times of scarcity. This means that many doctors do not feel supported by their government and are afraid of the medicolegal consequences of the choices they have to make. Consequently, there has been no transparent discussion among professionals and the public. The thought of being at the mercy of absolute arbitrariness leads to fear among the population, especially the vulnerable groups.

  • COVID-19
  • ethics
  • communication
  • end of life care
  • quality of life

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  • SN and ND are joint first authors.

  • Contributors SN and ND came up with the initial concept and thought out and laid out the main lines of the article. They were also jointly responsible for overall direction and planning. In terms of content, ND has mainly done the medical content concepts such as the Clinical Frailty Score and SN especially the ethical aspects such as the Fair Innings concept. Both ND and SN mainly shaped the introduction and the discussion. The contribution of SN and ND is similar. DP and AH have further refined and given more structure to the ethical concepts indicated by SN and ND. KvdW and JWdG designed the figures and the accompanying texts. KvdW especially for the ICU and JWdG for the general patient population. KCPV has mainly had a supervising role and an oversight role. All authors fully endorse the content of the article and share the view that SN and ND are joint first authors. According to Dutch custom, the first initial of a person’s full name determines the order. That is the ND fully agrees with that.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.