A major legal correction has emerged from Karlsruhe: Germany’s Federal Constitutional Court has declared the triage regulations adopted in late 2022 void. The court ruled that the legislation improperly restricted the professional freedom of intensive and emergency physicians, who must make life-and-death decisions in crisis situations.
The judges granted constitutional complaints filed by medical associations, who argued that the rules limited their ability to act ethically and responsibly under extreme pressure.
What triage means in medical emergencies
Triage — from the French trier, to sort — is a principle used when medical resources such as ICU beds or ventilators are insufficient for the number of patients. Physicians must then determine who receives urgent treatment first, based on chances of survival and immediate need.
During the COVID-19 pandemic, Germany faced overcrowded intensive care units, pushing triage from theoretical planning into real-world urgency.
How the 2022 law attempted to regulate these decisions
Responding to an earlier court mandate in 2021, the Bundestag introduced new rules designed to prevent discrimination against people with disabilities. The law required medical teams to base allocation solely on short-term survival prospects, explicitly excluding:
Long-term life expectancy
Degree of frailty or chronic conditions
It also introduced a strict prohibition on ex-post triage — meaning that once a patient was already receiving treatment, doctors were not allowed to reassign life-saving equipment even if another patient had significantly better chances of survival.
Medical experts, especially the Marburger Bund, warned that this forced physicians into impossible ethical dilemmas, potentially preventing them from saving the greatest number of lives.
Why the court declared the law unconstitutional
The ruling argues that Parliament went too far in restricting medical judgment:
- The legislation interfered with constitutionally protected professional autonomy
- Highly rigid rules did not reflect the complex reality of emergency care
- Doctors must retain clinical discretion in real-time critical situations
Therefore, the legislation is nullified, and lawmakers must now redesign the framework to meet constitutional standards.
What happens next?
With the triage law invalidated, the federal government must revisit the controversial topic. Any revised regulations will need to:
- Protect disability rights
- Allow physicians practical decision-making freedom
- Be adaptable to future crises beyond COVID-19
Health law experts expect extensive consultation with medical organisations before a new proposal moves forward.
A debate far from over
The ruling underscores lasting tensions from the pandemic: the challenge of balancing equal protection under the law with the reality of medical resource scarcity. For now, Germany returns to professional guidelines and ethical standards developed by emergency physicians — while politicians prepare for a second attempt that needs to withstand constitutional scrutiny.
