Which instruments make up the ethical framework within medical institutions?

Laws, guidelines (e.g. from the Swiss Academy of Medical Sciences, SAMW), statements of ethics commissions, internal guidelines and directives, forums for ethical discussion such as an ethics committee, case discussions, and procedures for ethical decisions in acute situations such as triage.

From binding to situational:

• Laws,
• guidelines, in Switzerland notably the medical-ethics guidelines of the SAMW (Swiss Academy of Medical Sciences), e.g. on intensive-care triage,
• statements of ethics commissions,
• internal guidelines and directives on specific topics,
• forums for ethical discussion (ethics committee, ethics forum),
• case discussions (Fallbesprechungen),
• ethical decision-making in acute situations.

The SAMW triage guidelines are a good example of the explicit, pre-set prioritisation rules that the rationing debate calls for: when ICU beds run short, the criteria are fixed in advance instead of being improvised by each doctor at the bedside. (The FMH is the professional association of Swiss doctors.)

Go deeper:

• SAMW: Medical-ethical guidelines (German) — all current Swiss guidelines.
• SAMW: Intensive care medicine — the triage guidelines in context.