Table 1

COVID-19 triage ethical guidance, published per country, with description of references to frailty, disability, equity and other relevant information

	Austria	Belgium	France	Germany	Greece	Ireland	Italy
Source(s)	Secretariat of the Bioethics Commission, Vienna; Austrian Society for Anaesthesiology, Resuscitation and Intensive Care	Belgian Society of Emergency and Disaster Medicine and the Belgian Resuscitation Council; Ethical Committee Care UZ Leuven	Azoulay et al 44; Comité Consultatif National d'Ethique	German Interdisciplinary Association for Intensive Care and Emergency Medicine	WHO Regional Office for Europe	Department of Health	Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care
Date of publication	31 March 2020; 17 March 2020	22 March 2020; 17 March 2020	5 June 2020; 13 March 2020	17 April 2020	August 2017*	27 March 2020	16 March 2020
‘Frailty’	Short-term prognosis using clinical risk assessment (COVID-19 severity, chronic disease/comorbidity, physical reserves)	Short-term prognosis and ‘good functional outcome’ using clinical frailty scale (severe comorbidity, chronic low quality of life, reduced cognition in elderly patients)	Baseline condition and frailty score (COVID-19 severity, age, comorbidities, neurocognitive status)	Short-term prognosis and clinical frailty scale (COVID-19 severity, comorbidities if relevant to current illness)	No unified national triage system	Short-term prognosis and premorbid and long-term functional health status (COVID-19 severity, comorbidities, frailty independent of age)	Short-term prognosis, life expectancy and functional status ‘Clinical suitability’ (COVID-19 severity, comorbidities)
Disability	Special support/resources for those with disability to ensure equal access and life chances	None	Notes that prioritising greater life expectancy could negatively impact those with disabilities	No exclusion on the basis of underlying illnesses/disabilities	No unified national triage system	None (though no single factor should be used as exclusion criteria)	None
Equity	No exclusion based on non-medical criteria (including age, quality of life)	Each individual should have access to same current standard of care or ‘the best possible spread … to the maximum amount of people’	Value of each individual recognised as absolute	All individuals considered equally and according to same criteria	No unified national triage system	Recognises the moral equality of all people Equal access to/chance of benefiting from healthcare	Allocation criteria apply to all intensive care patients
Other	Consider the will of the individual Transparency in documenting decision making Involve local ethics advisory service	Consider the will of the individual Transparency in documenting decision making Triage informed by expert team	Consider the will of the individual Transparency in documenting decision making Recommends strategies to reduce stigmatisation of groups facing social inequalities Involve local ethics advisory service	Consider the will of the individual Transparency to patients in decision making Involve local ethics advisory service	No unified national triage system	Consider the will of the individual Transparency to patients and in documenting decision making Involve stakeholders in preparedness planning	Consider the will of the individual Transparency to patients in decision making Second opinion useful for difficult cases Flexible/eligible for local adaptation
	Luxembourg	The Netherlands	Poland	Portugal	Spain	Switzerland	UK
Source	Commission Nationale d’Éthique	Royal Dutch Medical Association	Polish Society of Anaesthesiology and Intensive Therapy	National Council of Ethics for the Life Sciences	Spanish Society of Intensive Critical Medicine and Coronary Units	Swiss Academy of Medical Sciences	National Institute for Health and Care Excellence; British Medical Association; Royal College of Physicians
Date of publication	31 March 2020	16 June 2020	October 2012*	3 April 2020	21 March 2020	24 March 2020	29 April 2020; April 2020; 2 April 2020
Frailty	Short/medium term prognosis, general health	Short-term prognosis with clinical frailty score (including recovery time) but do not exclude ID/physical disability based on daily support needs	Short-term prognosis Chronic, severe, end-of-life comorbid illness	None	Short-term prognosis Chronic, severe, end-of-life comorbid illness	Short-term prognosis and perceived benefit of intensive care Chronic, severe, end-of-life comorbid illness	Short-term prognosis with clinical frailty score (comorbidities, benefit vs risk, quality of life) but should not be used for younger people, those with stable/chronic disabilities, autism/ID
Disability	Discrimination based on disability absolutely prohibited	Creating capacity for care in neurodevelopmental/residential care settings Should not consider ‘mental/physical limitation’, or prior quality of life	None	‘Special attention’ to vulnerable groups Avoid inequalities in access to diagnostics/treatments (eg, for those with chronic conditions)	Exclude ‘severe baseline cognitive impairment’	Discrimination based on chronic disability precluded	Duty to not disadvantage one group disproportionately (eg, disability) Caution indirect discrimination, for example, ‘first come first served’/‘capacity to benefit quickly’ may disadvantage those with disabilities
Equity	No exclusion based on non-medical criteria Value of each individual recognised as absolute All patients treated fairly and equally	Allocation criteria apply to all intensive care patients	None	Value of each individual recognised as absolute	Selection criteria must be equitably applied for all who would benefit from ICU	Equity crucial as recognised principle of medical ethics	Each individual matters equally; equal chance of benefiting from resources should mean equal chance of receiving them
Other	Consider the will of the individual Transparency to patients and in documenting decision making Involve local ethics advisory service	Transparency to patients and in documenting decision making ‘The right care in the right place’ (eg, consider home treatment) Triage informed by expert team	Focus on order of medical prioritisation, rather than inclusion/exclusion criteria	Transparency to patients and the public in decision making Remove decision making responsibility from individual care providers Case-by-case decision making	Consider the will of the individual Transparency to patients and in documenting decision making Involve local ethics advisory service Exclude those who need resources that cannot be provided	Consider the will of the individual Transparency in documenting decision making Triage informed by expert team	Consider the will of the individual Transparency to patients and in documenting decision making Involve local ethics advisory service Flexibility in adaptable circumstances

Malta is not included because no publicly available triage recommendations or documentation were identified.
*Current COVID-19 specific triage protocols were not identified, however existing information was available about allocation of resources in the case of shortages.
ID, intellectual disability.