Triage: That’s how difficult life and death decisions are

Medical studies often do not help young doctors with moral decisions.

Oliver Berg, picture alliance via Getty Images

Greta * is in her second year working as an assistant doctor at a clinic in an East German city. The young doctor already took over her first 24-hour work when she had just started two and a half weeks on the ward, she tells At that time, she supervised 40 patients alone and, even in critical situations, decides whether or not they will be transferred to the intensive care unit. Doubts cannot always be avoided.

Since the beginning of the pandemic, Greta has suddenly been confronted with much more extreme conditions in her service: “I fight every day to get an intensive care bed for my stroke patients,” says Greta. “I usually don’t have to argue about a bed for patients with critical conditions,” she says. However, like many others, the clinic belongs to a region in which not even 20 percent of all intensive care beds are free. There is not enough for all patients.

For young doctors like Greta, this often means moral stress: Even before the pandemic, it was difficult to make unambiguous decisions. In these conditions it is even more difficult for many.

Psychological stress was a major problem even before the pandemic

Medical ethicist Annette Rogge from Christian-Albrechts-Universität Kiel has been dealing with so-called moral stress among young doctors for a long time. It is a form of psychological stress and occurs above all when the doctors are unable to act as they think is morally justifiable due to external conditions. In the long run, this can even lead to burnout.

“The psychological stress was a big problem even before the pandemic, but now the moral issues are getting worse,” says Rogge. The main reason for this are the many uncertainties because doctors do not know how the number of infections would develop or how many intensive care beds would actually be needed by COVID-19 patients.

However, this creates the following problem: There is no one who can tell us: ‘This is how we have to do it, because I have had experience from numerous similar situations,’ ”explains Rogge. However, young doctors in particular have high expectations of wanting to help as well as possible. You could then quickly feel helpless if the usual medical care is not possible in times of pandemic.

“I felt so powerless,” says the young assistant doctor

Greta already knows such situations from her service in the past few weeks: “The last time a pensioner was admitted with a huge cerebral hemorrhage and complete paralysis on one side,” she says. Despite the critical condition, she would not have got a bed for him in the intensive care unit because he did not need ventilation. “The decision was just made over the phone,” she says. Not even a doctor came into the shock room to get an overview.

A few days later, the patient dies in a monitoring station, she says. For Greta this is difficult to understand: “I felt so powerless because the patient could have been saved,” she says. Later, she asked for a case discussion in order to work through the decision again with all colleagues. This should now take place soon.

Anette Rogge also considers more case discussions to be a good solution to moral stress. But she demands even more support for her young colleague: In hospitals there are now legally prescribed positions for hygiene officers. “The same should happen for clinical ethics counseling positions,” she says. Because moral stressful situations are also a problem regardless of the pandemic.

The alliance of young doctors is demanding more money for mentoring plans

However, the spokesman for the Alliance of Young Doctors, Max Tischler, does not go far enough: He believes that more staff and money are needed to provide mentors for young doctors.

“In the Corona period in particular, political pressure has to be built up so that hospitals and physicians in private practice receive sufficient financial resources for their staff and for training staff,” says Tischler. Mentoring plans ostensibly do not bring any money, which is why it is often not a priority for hospital owners. But young doctors should receive moral support even after a time of crisis when they have to make difficult decisions.

It was only in June that his alliance, with the support of other young associations, wrote an open letter to the Chancellor. It says: “If older doctors can no longer pass on their knowledge and skills to younger people because they don’t have the time, we are faced with a dramatic loss of quality that harms all of us.”

* The name was changed at the request of the doctor.

If you work in a hospital or in old people’s and nursing homes and have had similar experiences, please write to us. Notes are treated confidentially: joana.lehner (at)


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