{"id":38666,"date":"2020-03-31T11:23:15","date_gmt":"2020-03-31T09:23:15","guid":{"rendered":"https:\/\/www.datalex.ch\/expertises\/soins-intensifs\/"},"modified":"2020-04-11T02:08:14","modified_gmt":"2020-04-11T00:08:14","slug":"ethical-guidelines-intensive-care-units","status":"publish","type":"portfolio","link":"https:\/\/www.datalex.ch\/en\/expertises\/ethical-guidelines-intensive-care-units\/","title":{"rendered":"#4 \u2013 ETHICAL RULES FOR TRIAGE IN INTENSIVE CARE"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-jmxvxir7-95d89c55a18459ca75a45c2f5baa280d\">\n.avia-section.av-jmxvxir7-95d89c55a18459ca75a45c2f5baa280d{\nbackground-repeat:no-repeat;\nbackground-image:url(https:\/\/www.datalex.ch\/cms\/wp-content\/uploads\/2020\/03\/Virus-2-scaled.jpg);\nbackground-position:50% 50%;\nbackground-attachment:scroll;\n}\n<\/style>\n<div id='av_section_1'  class='avia-section av-jmxvxir7-95d89c55a18459ca75a45c2f5baa280d main_color 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--><\/div><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-k0ibabjl-8fe9bc842b2350b0a9dedad2ef664ba7\">\n.avia-section.av-k0ibabjl-8fe9bc842b2350b0a9dedad2ef664ba7{\nbackground-color:#ededed;\nbackground-image:unset;\nmargin-top:0px;\nmargin-bottom:0px;\n}\n<\/style>\n<div id='av_section_2'  class='avia-section av-k0ibabjl-8fe9bc842b2350b0a9dedad2ef664ba7 main_color avia-section-default avia-no-border-styling  avia-builder-el-2  el_after_av_section  el_before_av_section  avia-bg-style-scroll container_wrap sidebar_right'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-small alpha units'><div class='post-entry post-entry-type-page post-entry-38666'><div class='entry-content-wrapper clearfix'>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-22o2sp1-f2efabf4c0fdd900e21f044630e70c26\">\n.flex_column.av-22o2sp1-f2efabf4c0fdd900e21f044630e70c26{\nborder-radius:0px 0px 0px 0px;\n-webkit-border-radius:0px 0px 0px 0px;\n-moz-border-radius:0px 0px 0px 0px;\n}\n<\/style>\n<div class='flex_column av-22o2sp1-f2efabf4c0fdd900e21f044630e70c26 av_three_fourth  avia-builder-el-3  el_before_av_one_fourth  avia-builder-el-first  first flex_column_div av-zero-column-padding '   ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_heading-8e73635f1f24f162cd2acdcc5a508d79\">\n#top .av-special-heading.av-av_heading-8e73635f1f24f162cd2acdcc5a508d79{\nmargin:30px 30px 30px 30px;\npadding-bottom:40px;\ncolor:#253e43;\n}\nbody .av-special-heading.av-av_heading-8e73635f1f24f162cd2acdcc5a508d79 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-av_heading-8e73635f1f24f162cd2acdcc5a508d79 .special-heading-inner-border{\nborder-color:#253e43;\n}\n.av-special-heading.av-av_heading-8e73635f1f24f162cd2acdcc5a508d79 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-av_heading-8e73635f1f24f162cd2acdcc5a508d79 av-special-heading-h2 custom-color-heading blockquote modern-quote  avia-builder-el-4  el_before_av_textblock  avia-builder-el-first '><h2 class='av-special-heading-tag'  itemprop=\"headline\"  >\u00c9pisode #4 \u2013 Ethical Guidelines: What rules for triage in intensive care units?<\/h2><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-jlzlsr6x-5ab752379225619c4e2d35b21b1d3cc1\">\n#top .av_textblock_section.av-jlzlsr6x-5ab752379225619c4e2d35b21b1d3cc1 .avia_textblock{\ncolor:#000000;\n}\n<\/style>\n<section  class='av_textblock_section av-jlzlsr6x-5ab752379225619c4e2d35b21b1d3cc1'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock av_inherit_color'  itemprop=\"text\" ><p>This mini-series aims at providing legal guidance and recommendations to Swiss organizations during the uncertainty relating to the spread of the new coronavirus and the recent decisions from the Swiss authorities. This episode discusses how to define and use ethical principles for triage in intensive care units in the event of bottlenecks and lack of resources in hospitals.<\/p>\n<\/div><\/section><\/p><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-150b95x-96a9c176c269fa6b1b28f96316773e6d\">\n.flex_column.av-150b95x-96a9c176c269fa6b1b28f96316773e6d{\nborder-radius:0px 0px 0px 0px;\n-webkit-border-radius:0px 0px 0px 0px;\n-moz-border-radius:0px 0px 0px 0px;\n}\n<\/style>\n<div class='flex_column av-150b95x-96a9c176c269fa6b1b28f96316773e6d av_one_fourth  avia-builder-el-6  el_after_av_three_fourth  avia-builder-el-last  flex_column_div av-zero-column-padding '   ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_heading-97c602d7840b678c379006de73057a94\">\n#top .av-special-heading.av-av_heading-97c602d7840b678c379006de73057a94{\nmargin:30px 30px 30px 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href='https:\/\/www.datalex.ch\/en\/expertises\/covid-19-mini-legal-series\/' class='avia-color-theme-color avia-button avia-button-fullwidth av-k870wvse-c0f6ad9ce221b3968d1379d63fddae9c avia-icon_select-no avia-color-theme-color' ><span class='avia_iconbox_title' >All articles<\/span><span class='avia_button_background avia-button avia-button-fullwidth avia-color-theme-color'><\/span><\/a><\/div><br \/>\n<div  class='avia-buttonrow-wrap av-k7wi1fnq-faae17360d2ec182a730c1c1c15ac8ab avia-buttonrow-left  avia-builder-el-9  el_after_av_button_big  avia-builder-el-no-sibling '>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_buttonrow_item-8b20df2e2019ef2b2aa1b8ffc7c1976e\">\n#top #wrap_all .avia-button.av-av_buttonrow_item-8b20df2e2019ef2b2aa1b8ffc7c1976e{\nmargin-bottom:5px;\nmargin-right:5px;\n}\n<\/style>\n<a href='https:\/\/www.datalex.ch\/cms\/wp-content\/uploads\/2020\/04\/EN-datalex-Covid-19-Mini-series-Episode-4-Ethical-criteria-for-triage-in-intensive-care-units.pdf'  class='avia-button av-av_buttonrow_item-8b20df2e2019ef2b2aa1b8ffc7c1976e avia-icon_select-yes-left-icon avia-size-medium avia-color-theme-color'  ><span class='avia_button_icon avia_button_icon_left ' aria-hidden='true' data-av_icon='\ue805' data-av_iconfont='fontello'><\/span><span class='avia_iconbox_title' >Download Article (PDF)<\/span><\/a>\n<\/div><\/p><\/div><\/div><\/div><\/div><!-- close content main div --><\/div><\/div><div id='av_section_3'  class='avia-section av-qg9ikf-7243d56a031e29b48a82b516f33a1a22 main_color avia-section-default avia-no-border-styling  avia-builder-el-10  el_after_av_section  el_before_av_one_full  avia-bg-style-scroll container_wrap sidebar_right'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-small alpha units'><div class='post-entry post-entry-type-page post-entry-38666'><div class='entry-content-wrapper clearfix'>\n<section  class='av_textblock_section av-k867xm75-6b93d07b6a9ee2f54a8f37da82c30e5f'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-38533 alignleft\" src=\"https:\/\/www.datalex.ch\/cms\/wp-content\/uploads\/2020\/03\/Capture-d\u2019\u00e9cran-2020-03-31-\u00e0-11.47.54-300x199.png\" alt=\"\" width=\"300\" height=\"199\" srcset=\"https:\/\/www.datalex.ch\/cms\/wp-content\/uploads\/2020\/03\/Capture-d\u2019\u00e9cran-2020-03-31-\u00e0-11.47.54-300x199.png 300w, https:\/\/www.datalex.ch\/cms\/wp-content\/uploads\/2020\/03\/Capture-d\u2019\u00e9cran-2020-03-31-\u00e0-11.47.54-1030x684.png 1030w, https:\/\/www.datalex.ch\/cms\/wp-content\/uploads\/2020\/03\/Capture-d\u2019\u00e9cran-2020-03-31-\u00e0-11.47.54-768x510.png 768w, https:\/\/www.datalex.ch\/cms\/wp-content\/uploads\/2020\/03\/Capture-d\u2019\u00e9cran-2020-03-31-\u00e0-11.47.54-705x468.png 705w, https:\/\/www.datalex.ch\/cms\/wp-content\/uploads\/2020\/03\/Capture-d\u2019\u00e9cran-2020-03-31-\u00e0-11.47.54.png 1072w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/p>\n<p>We are facing dark historic days. Healthcare professionals (HCPs) are experiencing time trial to provide treatment to all patients with or without coronavirus-related respiratory disorders and save as many lives as possible. Where healthcare institutions lack of resources, which may happen under critical circumstances, hospitals may implement care rationing measures. With Covid-19, some patients are experiencing a &#8220;bad flu&#8221;. However, for the most vulnerable population, ventilators are needed in order to recover. The reality shows that this coronavirus pandemic is not sparing, especially for patients with risk factors. In the event hospitals are overloaded, have lack of equipment, of beds or staff, questions on triage criteria for admitting patients to intensive care units (ICU) arise in case of bottleneck and in case not all patients can be treated. Which patients should be selected and prioritized and according to which criteria? The Swiss Academy of Medical Sciences (<a href=\"https:\/\/www.samw.ch\/en.html\" target=\"_blank\" rel=\"noopener noreferrer\">SAMS<\/a>) and the Swiss Society of Intensive Care Medicine (<a href=\"https:\/\/www.sgi-ssmi.ch\/fr\/covi19.html\" target=\"_blank\" rel=\"noopener noreferrer\">SSMI<\/a>) have updated their joint guidelines called &#8220;<strong><em>Covid-\u200b19 pandemic: guidelines for triage in intensive care units<\/em><\/strong>&#8220;. In this 4<sup>th<\/sup> episode of our legal mini-series related to coronavirus, we discuss some basic legal rules and medico-ethical criteria for triage in ICUs.<\/p>\n<\/div><\/section>\n<\/div><\/div><\/div><!-- close content main div --><\/div><\/div><div id='after_section_3'  class='main_color av_default_container_wrap container_wrap sidebar_right'  ><div class='container av-section-cont-open' ><div class='template-page content  av-content-small alpha units'><div class='post-entry post-entry-type-page post-entry-38666'><div class='entry-content-wrapper clearfix'><\/p>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-wtf9al-630334b91bdcf1d1b66cd607bda1c073\">\n.flex_column.av-wtf9al-630334b91bdcf1d1b66cd607bda1c073{\nborder-radius:0px 0px 0px 0px;\n-webkit-border-radius:0px 0px 0px 0px;\n-moz-border-radius:0px 0px 0px 0px;\n}\n<\/style>\n<div class='flex_column av-wtf9al-630334b91bdcf1d1b66cd607bda1c073 av_one_full  avia-builder-el-12  el_after_av_section  avia-builder-el-no-sibling  first flex_column_div av-zero-column-padding '   ><section  class='av_textblock_section av-k86733ob-b5b8a60b43ce1bac297b678f6ee016eb'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h2>Q.1 Does Swiss law contain provisions on criteria to admit patients in ICUs?<\/h2>\n<p>A.1: Swiss law is based on general principles and therefore does not contain any specific provision on the criteria for triage of patient cases admitted to intensive care units (ICUs) in case of bottleneck. Case law specifies, on a case-by-case basis, whether a medical act complies or violates rules of medical standards. In the absence of such legislation, professional associations play a decisive role in defining those criteria and rules. They recently issued guidelines governing those ethical rules in intensive care units and emergency departments for triage protocols in the event of bottleneck cases.<\/p>\n<\/div><\/section><br \/>\n<section  class='av_textblock_section av-k86733ob-b5b8a60b43ce1bac297b678f6ee016eb'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h2>Q.2 What are the existing ethical rules that apply to intensive care units?<\/h2>\n<p>A.2. In June 2013, the SAMS already issued guidelines on &#8220;<a href=\"https:\/\/www.samw.ch\/dam\/jcr:99239135-d7e9-4dbd-bcc8-7d55511641ea\/guidelines_sams_intensiv_care_2013.pdf\">Intensive-care interventions<\/a>\u201d. Chapter 9.3 of those guidelines discusses and provide rules containing triage criteria in the context of limited resources where HCP may have to decide which patients should be prioritized.\u00a0 The SAMS and the SSMI have published online their &#8220;<a href=\"https:\/\/www.samw.ch\/dam\/jcr:c1f2b1d3-95d4-486a-8c59-e5668e74e97b\/guidelines_v2_sams_triage_intensive_care_resource_scarcity_20200324.pdf\">guidance<\/a>&#8221; for the implementation of Chapter 9.3 in the context of Covid-19, which specifies the criteria for deciding who to select for receiving treatment in priority.<\/p>\n<\/div><\/section><br \/>\n<section  class='av_textblock_section av-k86733ob-b5b8a60b43ce1bac297b678f6ee016eb'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><div class=\"page\" title=\"Page 1\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<div class=\"page\" title=\"Page 2\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<div class=\"page\" title=\"Page 2\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<div class=\"page\" title=\"Page 2\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<h2>Q.3 SAMS Guidelines are not considered as law: are they legally binding?<\/h2>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>A.3: From a legal point of view, the SAMS guidelines are <strong>not directly binding<\/strong>, as they are not included in a formal legislative act. However, according to the Swiss Federal Supreme Court: (our unofficial translation) &#8220;<em>SAMS guidelines enshrine the prevailing consensus in scientific medicine on health policy. They also serve as a reference for the courts and legislators (cantonal or federal) for regulating medical conduct<\/em>&#8221; (ATF 131 V 338, para. 5.4). These guidelines are an integral part of medical ethics; in particular, they are incorporated in the <a href=\"https:\/\/www.fmh.ch\/files\/pdf7\/standesordnung-fr-februar-2020.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Swiss Medical Code of Ethics<\/a> (\u201cSMCE\u201d in French) and apply to intensive care measures (Art. 18 SMCE). Therefore, even though the guidelines do not have same level as a law, they are considered as <strong>professional rules and standards<\/strong>, which the courts may use as a basis for assessing the state of knowledge of medical sciences. Therefore, except if a law or case law say otherwise, a judge may use those guidelines to interpret possible violations of the rules of medical.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/section><br \/>\n<section  class='av_textblock_section av-k86733ob-b5b8a60b43ce1bac297b678f6ee016eb'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><h2>Q.4 What are the criteria for triage in ICUs in the event of bottlenecks?<\/h2>\n<p>A.4: In the event of care rationing, resources and equipment must be reduced before care is provided. Then the usual medico-ethical principles (autonomy, beneficence, non-maleficence, justice) have to apply to fair and non-discriminatory procedures. In the case of a shortage of resources, three principles must apply: (1) <strong>fairness<\/strong>; (2) <strong>saving as many lives as possible<\/strong>; (3) <strong>protection of HCPs<\/strong>. In the case of limited resources, SAMS guidelines state that, on admission to intensive care, short-term prognosis is the decisive factor for triage. Patients with a favourable prognosis for discharge from hospital with intensive care therapy, but an unfavourable prognosis without intensive care, should receive highest priority. <strong>Age<\/strong> in itself is not a criteria to use. Neither do the draw or the &#8220;first come, first served&#8221; criteria apply. In addition, it is necessary to clarify in advance with all patients who are able to do so, their willingness in the event of complications. If intensive care measures are dispensed with, comprehensive palliative care must be guaranteed. Finally, limited resources must not be used on a patient who does not consent to them. Read: <a href=\"https:\/\/bullmed.ch\/journalfile\/view\/article\/ezm_saez\/fr\/bms.2010.15154\/fbbc5b2a2c38bc832fb5da55505bf88d23304096\/bms_2010_15154.pdf\/rsrc\/jf\" target=\"_blank\" rel=\"noopener noreferrer\">Triage in paediatric intensive care<\/a> (FR).<\/p>\n<\/div><\/section><br \/>\n<section  class='av_textblock_section av-k86733ob-b5b8a60b43ce1bac297b678f6ee016eb'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><div class=\"page\" title=\"Page 2\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<h2>Q.5 How have other countries resolved and discussed ethical guidelines?<\/h2>\n<p>A.5: In <strong>Italy<\/strong>, the <em>Societ\u00e0 Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva<\/em> <a href=\"http:\/\/www.siaarti.it\/News\/comunicato%20raccomandazioni%20di%20etica%20clinica%20siaarti.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">issued<\/a> recommendations (<a href=\"http:\/\/www.siaarti.it\/SiteAssets\/News\/COVID19%20-%20documenti%20SIAARTI\/SIAARTI%20-%20Covid19%20-%20Raccomandazioni%20di%20etica%20clinica.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">ITA<\/a>\/<a href=\"http:\/\/www.siaarti.it\/SiteAssets\/News\/COVID19%20-%20documenti%20SIAARTI\/SIAARTI%20-%20Covid-19%20-%20Clinical%20Ethics%20Reccomendations.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">EN<\/a>) to give the priority to patients with the greatest chance of therapeutic success, i.e. those with the greatest life expectancy. In <strong>Belgium<\/strong>, the <a href=\"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\" target=\"_blank\" rel=\"noopener noreferrer\">Belgian Intensive Care Society<\/a> did not issue national directives. Rather, it suggested that hospitals shall issue their own guidelines.\u00a0 It recommends the decide to admit or refuse cases in ICUs after discussing between 2 or 3 doctors experienced in respiratory distresses. In <strong>Germany<\/strong>, <a href=\"https:\/\/www.dw.com\/en\/coronavirus-german-doctors-lay-down-life-or-death-guidelines\/a-52925064\" target=\"_blank\" rel=\"noopener noreferrer\">7 associations<\/a> of doctors recommend priority to patients with the best chances of survival in ICUs. In <strong>France<\/strong>, the Comit\u00e9 Consultatif National d&#8217;Ethique (CCNE) has published its <a href=\"https:\/\/www.ccne-ethique.fr\/sites\/default\/files\/reponse_ccne_-_covid-19_def.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">contribution on ethical issues<\/a> in a pandemic situation. Finally, the <strong>Hastings Center<\/strong> created a <a href=\"https:\/\/www.thehastingscenter.org\/ethics-resources-on-the-coronavirus\/\" target=\"_blank\" rel=\"noopener noreferrer\">HUB<\/a> with resources and recommendations from various organizations.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/section><br \/>\n<section  class='av_textblock_section av-k86733ob-b5b8a60b43ce1bac297b678f6ee016eb'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><div class=\"page\" title=\"Page 2\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<h2>Q.6 Are there other rules when admitting patients in intensive care units?<\/h2>\n<p>A.6: All principles of medical law apply, even in an emergency situation. Therefore, every physicians have to comply with their duty of care, respectively to respect patient&#8217;s rights. If an unconscious patient arrives at the emergency room and cannot consent, the physician may administer medical care in accordance with his or her implied consent, meaning in the interest of the person incapable of discernment. Respecting self-determination in medical care becomes sensitive for patients that are unconscious at the time of the treatment. In such cases, physicians must act at all times in the <strong>patient&#8217;s best interests<\/strong> and respect the patient&#8217;s choice for the therapy (freely given and informed choice). The physician will then have to decide to act assuming the patient&#8217;s choice in it\u2019s best interest. An HCP may do so based on the degree of seriousness and the urgency required (art. 379 of the Swiss Civil Code &#8216;CC&#8217;). Any <strong>patient decree<\/strong> must also be respected. The doctor will act according to the rules <a href=\"https:\/\/www.datalex.ch\/en\/expertises\/telemedicine-legal-best-practices\/\" target=\"_blank\" rel=\"noopener\">of medical art<\/a> and with all the diligence required by the circumstances.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/section><\/p><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"featured_media":38535,"comment_status":"open","ping_status":"closed","template":"","tags":[479,577,563,636,638,635,634,490,639,642,568,641,573,518,637],"portfolio_entries":[575],"class_list":["post-38666","portfolio","type-portfolio","status-publish","has-post-thumbnail","hentry","tag-assm","tag-coronavirus","tag-covid-19","tag-ethical-guidelines","tag-health-lawyer","tag-icus","tag-intensive-care-units","tag-legal-advice","tag-medical-law","tag-medical-malpractice","tag-pandemic","tag-swiss-association-of-medical-sciences","tag-swiss-lawyer","tag-switzerland","tag-triage-rules","portfolio_entries-covid-19-mini-serie-en"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - 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