• Distributive Justice
• Ethics
• Resource Allocation
• War
• Clinical Ethics

In ‘Second Thoughts about Who’s First: The Medical Triage of Violent Perpetrators and Their Victims’ (in this issue), Gold and Strous challenge the ‘worst-first’ principle of medical triage—the principle that priority should be assigned exclusively on the basis of medical need. They argue that it is not justified when both terrorists and their victims have suffered life-threatening injuries and require immediate medical attention (‘terror-triage’ situations). In such situations, they claim, victims have priority. Gold and Strous do not limit their critique of the worst-first principle to terror-triage situations. Nevertheless, they consider such situations a paradigm case of justified exceptions to the worst-first principle, and terror-triage situations are the focus of much of their article as well as this commentary.

Gold and Strous' critique of the worst-first principle is based on what they refer to as three ‘dimensions’ of justice: retributive, distributive and corrective justice. Each, they claim, supports giving lower priority to perpetrators.

Retributive justice: From the perspective of retributive justice, people who commit unjustified acts of extreme violence, such as terrorism, undoubtedly deserve some type of punishment. However, it can be questioned whether a delay in life-saving medical care is an appropriate form of punishment. The authors provide no justification for their claim that ‘from a retributive point of view, it is justified to withhold the privilege of “blind medical triage” from terrorists as a quasi-punitive countermeasure due to their inferior moral status’ (p. 4). Even if it is conceded that ‘the sanction of downgrading their priority directly parallels …