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Second call for second thoughts: a response to Ardagh and Wicclair
  1. Azgad Gold1,
  2. Rael D Strous1,2
  1. 1Beer Yaakov Mental Health Center, Beer Yaakov, Israel
  2. 2Sackler Faculty of Medicine, Tel Aviv University, Israel
  1. Correspondence to Dr Azgad Gold, Psychiatry, Law and Ethics Unit, Beer Yaakov Mental Health Center, P. O. Box 1, Beer Yaakov 70350, Israel; azgadgo{at}

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Academic disputes are essential for illuminating complex ethical dilemmas. We are grateful to the editors of this journal for encouraging and enabling such a debate. Ardagh and Wicclair are to be commended for their thoughtful responses to our paper. Some of the points they have raised had been explicitly addressed in our article. Therefore, we would like to highlight three aspects which apparently have not been sufficiently addressed earlier.

A clarification of our view

Ardagh’s commentary exemplified to us how easily our view may be inadvertently oversimplified. Thus, first of all we would like to re-emphasise what we have argued and what we have not argued.

Our main argument is presented by Ardagh as follows: ‘during terrorist inflicted mass casualty incidents, triage should be modified so that victims are given priority for medical care before any injured terrorists’. This description is different from our main argument in three aspects. First, we do not limit our argument to terrorists, but rather the terror-triage dilemma was used as a case-study of terror-like situations. Second, and more importantly, we presented the argument that severely injured victims should receive treatment before terror-like perpetrators, even if their medical condition is worse. We never argued that a victim who suffers from a minor injury should receive medical treatment before a critically injured terror-like perpetrator, as can be misunderstood by Ardagh’s description. Third, we state that the worst-first policy in not ethically illegitimate even if the ethical argument for the victim-first side may appear stronger.

Similarly, clustering the terror-triage situation along with ‘paedophiles injured while being detained by the police’ or ‘perpetrators and… victims… in adjacent cubicles’ in the emergency room ignores the unique and limited circumstances that specifically characterise the terror-triage dilemma, as we have previously explained in length.

In addition, we have not argued that physicians should ‘act as …

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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