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Guest article by Dr.med. Erich Theo Merholz, President, Association Européenne des Médecins des Hôpitaux

The healthcare system has drastically changed over the last year as European hospitals responded to the pandemic and focused on the treatment of COVID-19 patients. The reduction of ICU capacity had a dramatic effect with almost certainly lives being lost when adequate treatment was often not available, and the implementation of a triage system to allocate scarce resources. Only a handful of countries that did not cut back on their ICU capacities, such as Austria, Germany or Switzerland, were able to avoid these consequences.

Ultimately, ICU capacities have been expanded and special wards established. However, this meant that elective treatments were suspended, as personnel was transferred to the new COVID wards. In some countries, the capacities for intensive care treatment did not suffice and patients had to be transferred abroad or did not receive the treatment they needed. Patients paid a high price for economic cutbacks, highlighting the need for national governments to re-evaluate the adequacy of their hospital capacity in times of crisis.

Often working beyond their limits, doctors and nurses have proven clinical leadership and the ability to cope under pressure. As well as the lack of ICU capacity, the limited availability of personal protective equipment at the start of the pandemic was an additional challenge.

COVID-19 has posed ethical challenges and contested medical practice across European hospitals. Some of these challenges were addressed at national and European level, yet the discussions are often fragmented due to different cultures and legal frameworks across EU national governments. To facilitate the dialogue, the AEMH (Association Européenne des Médecins des Hôpitaux) (European Association of Senior Hospital Physicians) is implementing a European Working Group on Bioethics and Deontology in cooperation with other European medical organizations. This Working Group aims to establish a common European basis to respond to these challenges to ensure patients receive the care they need during a crisis.

The pandemic has become a turning point for our healthcare systems. Each Member State must evaluate its performance and address the structural shortcomings which emerged during the crisis. The pandemic has also highlighted the need to strengthen the EU’s role in coordinating health care and providing trans-border assistance, revealing the limits of so- called subsidiarity of Member States in times of crisis and the importance of supranational EU-bodies in ensuring a coordinated response.