Veralltäglichung der Triage?

Abstract.

Definition of the problem: In disaster medicine, allocation of scarce resources to patients (triage) is oriented towards maximizing the number of survivors. In everyday medicine, rationing according to this principle is less accepted and may even be scandalized because it discriminates against ”expensive” patients. How is the difference to be accounted for, and will it remain stable? Arguments: It is argued that utilitarian aggregation (be it of pain or of deaths) is not morally respectable as such. Acceptance of triage in disaster medicine is due to the fact that in advance of the disaster everybody’s own interest lies in a procedure which maximizes survivors (ex ante-consensus). A general transfer of this idea to everyday medicine is not plausible because in this area there is much more ex ante-knowledge as to who will be the winner or the loser when the maximizing rule is adopted. Other factors which, in addition, help to assess the status of the maximizing rule are also discussed. Conclusion: It is not to be expected (and it is not justifiable) that under increasing cost pressure, the maximizing rule will become a general and uncontested ethical principle for rationing in everyday medicine.

Zusammenfassung.

Der Beitrag diskutiert die ethischen Grundlagen der sogenannten Triage (der Sortierung von Behandlungsbedürftigen in Dringlichkeitskategorien beim Massenanfall Verwundeter) und prüft, inwieweit eine Übertragung dieser Praxis auf eine unter Rationierungsdruck geratende Alltagsmedizin begründbar bzw. zu erwarten ist. Insbesondere wird der ethische Status der sog. Maximierungsregel („rette so viele Menschenleben wie möglich”) erläutert, und es werden die bereits in der katastrophenmedizinischen Praxis nicht ganz unwirksamen Grenzen der Orientierung an dieser Regel deutlich gemacht.