Swiss doctors have urged those vulnerable to Covid-19 complications to record their wishes for end-of-life care in advance to help ease pressure on intensive care units, drawing criticism from an advocacy group.
Pro Senectute Schweiz, an organisation for the elderly, said the doctors’ appeal was premature and excessive but medics insist such patient decrees are necessary in the heart-wrenching reality of caring for critical patients during the pandemic.
As health systems grapple with soaring infection rates, medical professionals working with limited resources and finite space in ICUs can at times face agonising dilemmas, and ethical questions around treating Covid patients have spawned a government review in Britain and a court fight in Germany.
Warning that Switzerland was running low on intensive care beds, the Swiss Society for Intensive Care Medicine (SGI) called this week on the “especially imperilled”, including people over 60, or with health conditions like heart disease and diabetes, to put their wishes on paper in case the worst should happen.
“This will support your own relatives, but also the teams in the ICUs, as they make decisions so the treatment can be done in the best possible manner according to the individual patient wishes,” SGI said in a statement.
Pro Senectute Schweiz said the call by the SGI, while in normal times sensible advice, created an impression of urgency inappropriate for a decision that demands deep consideration.
“The SGI appeal... takes place in the context of an absolute emergency situation in which Switzerland does not yet find itself in,” the group said.
SGI president Thierry Fumeaux, an ICU doctor in the western Swiss city of Nyon, said the group was not aiming to put anyone under pressure or to free up beds, only to encourage them to think ahead.
“This is even more important in a time when vulnerable people are at high risk of having an infection, at high risk of being admitted to an ICU, and at high risk of dying,” Fumeaux said. “This is not a call for sacrifice. It’s just a call to take responsibility for their autonomy.”
Antonio Cuzzoli, who was head of intensive care at northern Italy’s Cremona Hospital until July, said that as the coronavirus made the Lombardy region ground zero for infections in March and April, some patients committed “acts of heroism” by refusing treatment.
Italy has a “declaration of renouncement of invasive treatment”, but some in the pre-dominantly Roman Catholic country may refuse it on the basis that it conflicts with their faith, Cuzzoli said.
Still, some ICU doctors said the Covid-19 crisis had shown how making such a plan could spare unwanted suffering.