In 2020, the USA experienced an extreme situation in which medical professionals had to answer essential medical ethics questions regarding rationing and prioritization. In Germany and Switzerland, the vast majority of people, with or without work, are covered by health insurance, especially in the less affluent classes. Scenes like those in New York toward the end of April, where seriously ill people were being turned away from hospitals, were completely unimaginable. European medicine has learnt a great deal from its US counterpart: both the modern US hospital system and the basic assumptions of US medical ethics have been copied on the other side of the Atlantic. The pandemic shows that US medicine not only has to suspend ethical principles due to the particular situation (e.g., triage) but that some ethical principles can hardly be observed in other situations, as the healthcare system hardly allows this.

During one of its peaks in the ongoing COVID-19 pandemic, for instance in New York City, the wide gulf between the ideals of US medical ethics and the reality of the enormous disparities in the US health system became obvious to a worldwide audience. This has been the case for not only medical ethics but also the US hospital system, which for decades has set the tone worldwide. What do US medical ethics and US hospital construction concretely offer that would help in the context of this pandemic and of a wider future in the sense of enfolding something that is already a prominent part of the US health system? When US President Donald Trump visited a mask factory in Arizona on May 5, 2020, the public relations department selected the song “Live and Let Die” by the band Guns N' Roses as the background music (1). It does not refer to the ethical measures of rationing and prioritization that are currently prevalent in the US healthcare system when we look at the global significance of American medical ethics and the US hospital system in recent decades.

In 2020, most parts of the world experienced an extreme situation in which medical professionals had to answer essential medical ethics questions regarding rationing and prioritization. Some countries, such as Germany, Switzerland, and the USA, had a medically favorable starting position when the pandemic began. Medical supplies and hospital equipment were in such good order that rationing and prioritization in connection with the pandemic has so far only occurred in rare cases (2). However, there was a considerable difference between those countries. Meanwhile we heard about a lot of patients who could not be treated due to a lack of health insurance coverage (3). At present, it is precisely the southern states that are affected, where many people do not have insurance (4, 5). Elsewhere, this situation is impossible: for instance, in Germany and Switzerland, the vast majority of people, with or without work, are covered by health insurance, especially in the less affluent classes. Scenes like those in New York toward the end of April, where seriously ill people were being turned away from hospitals, were completely unimaginable. It was incomprehensible to think that this could happen in the USA, a country that has always set an example to those of us who work, research, and teach as medical ethicists and historians (6). But it should come as no surprise, because the reality is this problem has always existed in the US healthcare system, but now it has become more apparent in the context of the pandemic. The contradiction with medical ethics is also more apparent here, as it has now become clear to the entire world for the first time.

More than 40 years ago, two US medical ethicists, Beauchamp and Childress (7), first published their four principles under the title Principles of Biomedical Ethics. Both probably taught the four basic assumptions to their students in such a prayer-mill-like canon that they called it the “Georgetown Mantra”: respect for autonomy, non-maleficence, beneficence, and justice. The Georgetown Mantra became the most influential text for the development of the discipline of medical ethics, not only in the USA, but also around the world. In recent years, research in ethics has been searching for answers to this question of humane healthcare with the help of the Georgetown Mantra: can the patient maintain self-determination in the absence of health insurance coverage, especially in times of a pandemic? How do I come to a decision in a triage situation? Do I fulfill my duty of care as a hospital employee? Do I not harm the patient? Is there social justice in answering a medical–ethical dilemma? In most university hospitals, this mantra is an integral part of medical education. However, also many current examples from the USA show medical ethicists from Europe that US medicine in particular is finding it difficult at present to recognize two of the most widely replicated principles developed at Georgetown University. In the following, we would like to explain some current examples based on the mantra:

European medicine has learnt a great deal from its US counterpart: both the modern US hospital system and the basic assumptions of US medical ethics have been copied on the other side of the Atlantic. Both Beauchamp and Childress as well as Franklin, Mayo, and Davis were not only pioneers for the healthcare system in the USA but have had far-reaching significance in the history of hospitals and ethics of medicine in Europe to this day.

But at this point, an appeal should be made again based on the ongoing experience of the COVID-19 pandemic for a fair hospital system closely following Franklin's and Mayo's models and the ideas in the Georgetown Mantra.

The normal ethical principles are replaced by triage. The pandemic shows that US medicine not only has to suspend ethical principles due to the particular situation (e.g., triage) but that some ethical principles can hardly be observed in other situations, as the healthcare system hardly allows this. With this text, we want to launch a discussion as to why so many achievements, which were once established by US university ethics and which are taught worldwide in order to make even better use of the achievements of the US hospital system, have fallen into oblivion in the USA today.