Have things really reached that point again? This question arises with the latest news from the German district of Tuttlingen in the state of Baden-Württemberg, where the district is pressuring elderly care and nursing homes to evaluate whether transferring their residents to hospital in the event of a COVID-19 infection is really worthwhile. And all parties, including the Left Party, defend this call for preventive triage, which is reminiscent of the darkest period in German history.
“You know your residents,” states the undated letter which reached the care facilities in early December. “You can determine their presumed or actual will, and through your actions you can do a great deal to prevent the available treatment resources from being overloaded.”
The letter from the Tuttlingen district is signed by Dr. Sebastian Freytag, Managing Director of Tuttlingen District Hospital Ltd., as well as Bernd Mager, head of social affairs. The latter is both the department head of the district for labor and social affairs and a member of the regional executive of the Christian Democrats (CDU) in Tuttlingen.
It is worth studying this letter, with the seal of an official German authority, carefully. It begins with the reference to the “current wave of the coronavirus pandemic” and the “very critical” situation at the local hospital. This had “reached the capacity limit both in terms of the utilization of the intensive care unit and in terms of personnel.” The “ladies and gentlemen of the inpatient facilities and outpatient services” and the relatives and residents in the Tuttlingen district should bear in mind that “every bed in which people in need of intensive care are cared for … requires a staff of skilled workers, a resource, which is limited in the short term!”
With the scarce resource of intensive care, the following “urgent appeal” is justified at the end: “We ask those responsible for the inpatient facilities and outpatient services to sensitize the residents, clients and their relatives to this, especially by carefully considering hospital admissions during this difficult time. This also applies to the use of emergency medical services.”
By being reluctant to approve hospital admissions, the resources of clinical intensive and emergency care could ultimately be left open to those “whose diseases are associated with a good prognosis with a view to extending life with a good quality of life,” the letter reads.
In order to record the “presumed or actual will” (as it says in the letter) of the resident, the district attached a document to the letter headlined “Assessment on the occasion of the COVID-19 pandemic.” It is a one-page form with which an existing will can be “supplemented” with a resident’s wishes regarding care. However, as the letter expressly states, the form can “also be filled out and handed in explicitly without a prior will”—a procedure that is obviously in a legal gray area.
The person concerned must tick a box on the form to indicate whether they want to be transferred to hospital “in the event of a severe COVID 19 disease,” undergo emergency therapy with or without invasive ventilation, or only want to receive palliative care to relieve pain and symptoms. They must expressly sign that these declarations “also apply without medical advice regarding my desired or rejected form of treatment.”
One rubs one’s eyes. Here, the specialist care staff is asked quite bluntly to distinguish at an early stage among the people entrusted to their care between those with a “good prognosis with a view to extending life with a good quality of life” from those whose lives are consequently to be regarded as worthless—“Especially elderly and very old people, many with serious comorbidities,” as the letter says. Inevitably, images from the worst period of the Nazi dictatorship come to mind, when in the interests of the “national community” supposedly “unworthy life” was destroyed.
The letter from the Tuttlingen district office was met with horror and outrage from the public. In a letter on December 7, the St. Francis Foundation, which operates several care facilities, expressed its “great concern” and urgently asked the district office to withdraw its appeal.
“Our mission as a service provider is to ensure help, care and support for very vulnerable social groups,” wrote the church foundation. “In this regard, we also help these groups of people to exercise their basic rights. We do not see our mission in keeping people away from the support and care structures to which they are entitled.”
The spokesman for Caritas Disability Aid, Wolfgang Tyrychter, also protested the actions of the Tuttlingen district authorities. Die Welt quoted him as saying, “As a service provider for people of old age and with disabilities, we reject the demand to make a preselection before possible hospital admissions and to use the hospital system only cautiously.”
Picking out particularly vulnerable groups and asking them to think twice about whether they actually want intensive care treatment in an emergency is discriminatory, said Tyrychter. On public broadcaster ARD’s “Mittagsmagazin” he explained, “We have to be able to rely on the fact that people in old age, people with disabilities, will first receive the medical help that everyone else gets.”
The organization AbilityWatch, which represents the interests of the disabled, published a piece on its website under the title “Pure horror! Triage in Tuttlingen.” Regarding the letter from the Tuttlingen district, the organisation raises legitimate questions: “How does the Tuttlingen district define quality of life? Are we seriously asking such questions again in Germany? And in public and without a feeling of shame?”
The district office defended its position on December 15 in an angry statement that is still available today on the official website of the district, along with the original letter, the declaration form and the letter from the Franziskus Foundation. “We would like to stick to this urgent and reality-oriented appeal. We still consider we are right on this issue,” it states. It is not expedient to “argue over basic rights to medical care.”
“Never again,” it was said in the postwar period. Society would never be allowed to sink into barbarism again, to send the old, the infirm or the handicapped to their deaths in a targeted manner. But COVID-19 has made it possible. Indifference to human life is dictating the response of all governments to the pandemic. Instead of consistently fighting the pandemic, profits are put above lives.
In April 2020, the then president of the federal parliament, Wolfgang Schäuble (CDU), laid down the law when he told Tagesspiegel, “But when I hear that everything else has to step back in order to protect life, then I have to say: That is not correct in this absoluteness. Fundamental rights are mutually limiting. If there is one absolute value in our Basic Law, then it is the dignity of the person. But that does not exclude us from having to die.”
Boris Palmer (Green Party) is the mayor of Tübingen. He put it particularly brutally at the time—“We may save people who would be dead in six months anyway”—to justify his call for an end to all COVID-19 public health measures that restrict the economy.
With the latest letter from the Tuttlingen district, an alarming new stage has been reached in the ruling elite’s pandemic policy, which includes refusing to take any serious measures even against the highly contagious Omicron variant. Olaf Scholz’s traffic light coalition government is even more ruthless on this issue than was Merkel’s grand coalition.
While the German stock exchange climbs ever higher, thousands of COVID-19 patients are dying a premature and gruesome death over the second Christmas period in a row. The terrible toll of 110,000 coronavirus deaths has already been exceeded. Now, the consequences of the total overwhelming of nursing staff in the intensive care units and emergency care are being borne by the weakest, who are least able to defend themselves—the elderly and disabled people in need of care.
The triage recommendation of the Tuttlingen district is not only supported by the CDU, which heads the social affairs department. Politicians of all stripes, including the Left Party, have defended the appeal.
Philipp Polster, who ran for the Left Party in Tuttlingen in 2021, defended the “core of the message” as “still correct” on Twitter, citing the “right to die.” “The right to die also applies to nursing home residents and … applies to people who can no longer express their will. … The clinic/LK [district] has only called for all homes to clarify exactly these cases. ... I think that’s right,” he wrote. Polster’s tweet was also liked and commented on positively by the local Social Democrats.
The triage recommendation in Tuttlingen shows once again that ending the pandemic requires a political struggle and the mobilization of the working class. To eliminate COVID-19, an internationally coordinated lockdown is necessary, which shuts down all nonessential businesses, closes schools and day care centers and fully compensates workers. All governments and established parties have no intention of carrying out such measures.