#and i wont wake up w death threats in my inbox

[coe-lilium]

There’s a post making rounds on my dash in which the 2nd blogger (not counting OP) went “doctors never ever decide not to treat, people just get moved to another hospital ward” in answer to an Italian blogger saying “our doctors will have to chose if things gets bad enough” that had me troubled for a couple days because it implied (unwillingly, I’m sure) that a good chunk of Italian doctors were actively lying about such a topic being considered.

So I went to do some digging. 

And as it turns out, the Italian poster who has now deactivated was at least partly right because these guidelines exist, are real and legit and have been published by the SIAARTI (Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care), not by a fear mongering nobody nor they are the hallucination of a now-probably-bullied-out-of-tumblr fellow. 

The document is titled (eng translation) Clinical ethics recommedations for the admission to intensive treatments and for their suspension in exceptional conditions of imbalance between needs and available resources, published March 6th 2020.

Some extracts from the introduction (w translation)  

Le  previsioni  sull’epidemia  da  Coronavirus  (Covid-19)  attualmente  in corso in  alcune  regioni  italiane  stimano  per  le  prossime  settimane,  in molti centri,  un  aumento  dei  casi  di  insufficienza  respiratoria  acuta (con necessità di ricovero in Terapia Intensiva) di tale entità da determinare un enorme squilibrio tra le necessità cliniche reali della popolazione e la disponibilità effettiva di risorse intensive.

eng: 

The forecasts for the Coronavirus epidemic (Covid-19) currently underway in some Italian regions estimate for the coming weeks in many centers an increase in cases of acute respiratory insufficiency (with the need for ICU admission) to determine a huge imbalance between the real clinical needs of the population and the effective availability of intensive resources

and more

Come  estensione  del  principio  di  proporzionalità  delle  cure,  l’allocazione  in  un  contesto  di  grave  carenza (shortage) delle risorse sanitarie deve puntare a garantire i trattamenti di carattere intensivo ai pazienti con maggiori possibilità di successo terapeutico: si tratta dunque di privilegiare la “maggior speranza di vita”. Il bisogno di cure intensive deve pertanto essere integrato con altri elementi di “idoneità clinica” alle cure intensive, comprendendo quindi: il tipo e la gravità della malattia, la presenza di comorbidità, la compromissione di altri organi e apparati e la loro reversibilità. Questo comporta di non dover necessariamente seguire un criterio di accesso alle cure intensive di tipo “first come, first served”

eng:

As an extension of the principle of proportionality of care, the allocation in a context of serious shortage (shortage) of health resources must aim to guarantee intensive treatments for patients with greater chances of therapeutic success: it is therefore a matter of privileging the "greatest life expectancy ". The need for intensive care must therefore be integrated with other elements of "clinical suitability" for intensive care, thus including: the type and severity of the disease, the presence of comorbidity, the compromise of other organs and systems and their reversibility. This means not necessarily having to follow a criterion of access to intensive care of the "first come, first served" type

The actual guidelines follows, but you get the hint (and as I’m not translator I’m not even attempting to go through all 15 of them). 

In short: NO, older people in Italy aren’t about to be dumped like they’re nothing and everything will be attempted but yes, it is THAT bad already and as horrific as it is selection for treatment IS being considered and NO, sometimes you cannot “just move them to another ward”.   

Sources: 

The SIAARTI site

The press release on the guidelines, talking about “every doctor may find himself having to make lacerating decisions in a short time from an ethical as well as a clinical point of view: which patients undergo intensive treatments when the resources are not sufficient for all patients who arrive, not all with the same chance of recovery”   

The actual document

An english article (no paywall) I was able to find on the subject

A twitter 3D translating some of the document guidelines (written by the writer of the above article) 

The unroll of the above twitter 3D, easier to read