Shortages of life-saving medical resources caused by COVID-19 have prompted hospitals, healthcare systems, and governmentsto develop crisis standards of care, including 'triage protocols' to potentially ration medical supplies during the public health emergency. At the same time, the pandemic has highlighted and exacerbated racial, ethnic, and socioeconomic health disparities that together constitute a form of structural racism. These disparities pose a critical ethical challenge in developing fair triage systems that will maximize lives saved without perpetuating systemic inequities. Here we review alternatives to 'utilitarian' triage, including first-come first-served, egalitarian, and prioritarian systems of allocating scarce medical resources. We assess the comparative advantages and disadvantages of these allocation schemes. Ultimately, we argue that while triage protocols should not exacerbate disparities, they are not an adequate mechanism for redressing systemic health inequities. Entrenched health disparities must be addressed through broader social change.
- resource allocation
- social aspects
- legal aspects
This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.https://bmj.com/coronavirus/usage
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Contributors BT: conception of work, drafting of manuscript, critical revision of manuscript, final approval of published version. SCH and KK: conception of work, critical revision of manuscript, final approval of published version.
Funding BT is supported by a VISN1 Career Development Award from the US Department of Veterans Affairs.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement There are no data in this work.
Read the full text or download the PDF:
Other content recommended for you
- COVID-19 pandemic, the scarcity of medical resources, community-centred medicine and discrimination against persons with disabilities
- Promoting racial equity in COVID-19 resource allocation
- Ethics of reallocating ventilators in the covid-19 pandemic
- Allocating scarce life-saving resources: the proper role of age
- Who should get the scarce ICU bed? The US public’s view on triage in the time of COVID-19
- Identifying ethical values for guiding triage decisions during the COVID-19 pandemic: an Italian ethical committee perspective using Delphi methodology
- Should healthcare workers be prioritised during the COVID-19 pandemic? A view from Madrid and New York
- National health system cuts and triage decisions during the COVID-19 pandemic in Italy and Spain: ethical implications
- Who will receive the last ventilator: why COVID-19 policies should not prioritise healthcare workers
- Triage during the COVID-19 epidemic in Spain: better and worse ethical arguments