This article provides an introduction to Estonian clinical ethics recommendations concerning the distribution of limited health care resources during the COVID-19 pandemic. We will give a short overview of the process of compiling the Estonian document, including stakeholder involvement, engagements with comparable international documents, main internal debates and lessons learned for the future.
Berlinger, N., Wynia, M., Powell, M., Hester, M., Milliken, A., Fabi, R., Cohn, F., Guidry-Grimes, L. Watson, J. C., Bruce, L., Chuang, E. J., Oei, G., Abbott, J., and N. P. Jenks (2020) “Ethical framework for health care institutions responding to Novel Coronavirus for institutional ethics services responding to COVID-19. managing uncertainty, safeguarding communities, guiding practice”. The Hastings Centre, 16 March. Available online at
<https://www.thehastingscenter.org/ethicalframeworkcovid19/>. Accessed on 19 May 2020.
BMA (2020) “COVID-19: ethical issues. a guidance note”. Updated 12 May. Available online at
<https://www.bma.org.uk/advice-and-support/covid-19/ethics/covid-19-ethical-issues>. Accessed on 19 May 2020.
Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI) (2020) „Entscheidungen über die Zuteilung von Ressourcen in der Notfall- und der Intensivmedizin im Kontext der COVID-19-Pandemie. Klinisch ethische Empfehlungen der Deutscnen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI), der Deutschen Gesellschaft für Interdisziplinäre Notfall- und Akutmedizing (DGINA), der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), der Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), der Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), der Deutschen Gesellschaft für Palliativmedizin (DGP) und der Akademie für Ethik in der Medizin (AEM)”. 25 March. Available online at
<https://www.divi.de/empfehlungen/publikationen/covid-19/1540-covid-19-ethik-empfehlung-v2/file>. Accessed on 19 May 2020.
Deutscher Ethikrat (2020) “Solidarity and the responsibility during the Coronavirus crisis: ad hoc recommendation”. 27 March. Available online at
<https://www.ethikrat.org/fileadmin/Publikationen/Ad-hoc-Empfehlungen/englisch/recommendation-coronavirus-crisis.pdf>. Accessed on 19 May 2020.
Lübbe, W. (2020) “Corona-Triage”. 15 March. Available online at
<https://verfassungsblog.de/corona-triage/>. Accessed on 19 May 2020.
Meyfroidt, G., E. Vlieghe, P. Biston, K. De Decker, X., Wittebole, P. Depuydt, Nam, N. G., Hermans, G., Joren, P., Ledoux, D., Taccone, F., and I. Devisch (2020) “Ethical principles concerning proportionality of critical care during the 2020 COVID-19 pandemic in Belgium: advice by the Belgian Society of Intensive Care Medicine”. 18 March 2020. Available online at
<https://www.hartcentrumhasselt.be/professioneel/nieuws-professioneel/ethical-principles-concerning-proportionality-of-critical-care-during-the-covid-19-pandemic-advice-by-the-belgian-society-of-ic-medicine>. Accessed on 19 May 2020.
NICE. National Institute for Health and Care Excellence (2020) “COVID-19 rapid guideline: critical care in adults”. 20 March. Available online at
<https://www.nice.org.uk/guidance/ng159/resources/covid19-rapid-guideline-critical-care-in-adults-pdf-66141848681413>. Accessed on 19 May 2020.
Nõmper. A. (2020) “Kriisi süngeim tund arsti jaoks: valik patsientide vahel”. [The darkest hour of the crisis for the doctor: the choice between patients.] Available online at
<https://www.delfi.ee/news/paevauudised/eesti/kriisi-sungeim-tund-arsti-jaoks-valik-patsientide-vahel?id=89478639>. Accessed on 19 May 2020.
Österreichische Gesellschaft für Anesthesiologie, Reanimation und Intensivmedizin (2020) “Allokation intensivmedizinischer Ressourcen aus Anlass der Covid-19-Pandemie. Klinisch-ethische Empfehlungen für Beginn, Durchführung und Beendigung von Intensivtherapie bei Covid-19-Patientinnen”. 17 March. Available online at
<https://www.oegari.at/web_files/cms_daten/covid-19_ressourcenallokation_gari-statement_v1.7_final_2020-03-17.pdf>. Accessed on 19 May 2020.
Statista Research Department (2020) “Coronavirus (COVID-19) death rate in Italy as of May 13, 2020, by age group”. Available online at <https://www.statista.com/statistics/1106372/coronavirus-death-rate-by-age-group-italy/>. Accessed on 19 May 2020.
Sutrop, M. (2020) “Margit Sutrop: Soovitused rasketeks valikuteks”. [Margit Sutrop: Recommendations for difficult choices.] Available online at
<https://leht.postimees.ee/6944396/margit-sutrop-soovitused-rasketeks-valikuteks>. Accessed on 19 May 2020.
Swiss Academy of Medical Sciences (2020) “COVID-19 pandemic: triage for intensive-care treatment under resource scarcity”. Updated 24 March. Available online at
<https://smw.ch/article/doi/smw.2020.20229>. Accessed on 19 May 2020.
https://doi.org/10.4414/smw.2020.20229
Values Game for Medics (n.d.) Available online at
<https://www.eetika.ee/en/values-development/values-game-medics>. Accessed on 19 May 2020.
Vergano, M., G. Bertolini, A. Giannini, G. Mistraletti, and F. Petrini (2020) “Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances”. Available online at
<http://www.siaarti.it/SiteAssets/News/COVID19%20-%20documenti%20SIAARTI/SIAARTI%20-%20Covid-19%20-%20Clinical%20Ethics%20Reccomendations.pdf>. Accessed on 19 May 2020.
https://doi.org/10.1186/s13054-020-02891-w
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