Article Text

Download PDFPDF
Triage and justice in an unjust pandemic: ethical allocation of scarce medical resources in the setting of racial and socioeconomic disparities
  1. Benjamin Tolchin1,2,3,
  2. Sarah C Hull4,5,
  3. Katherine Kraschel6
  1. 1 Neurology, Yale School of Medicine, New Haven, Connecticut, USA
  2. 2 Epilepsy Center of Excellence, VA Connecticut Healthcare System, West Haven, Connecticut, USA
  3. 3 Adult Ethics Committee, Yale New Haven Hospital, New Haven, Connecticut, USA
  4. 4 Cardiology, Yale School of Medicine, New Haven, Connecticut, USA
  5. 5 Program for Biomedical Ethics, Yale School of Medicine, New Haven, Connecticut, USA
  6. 6 Solomon Center for Health Law & Policy, Yale Law School, New Haven, Connecticut, USA
  1. Correspondence to Dr Benjamin Tolchin, Neurology, Yale School of Medicine, New Haven, CT 06510, USA; benjamin.tolchin{at}


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.

  • minorities
  • 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.

Statistics from

Request Permissions

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.


  • Twitter @btolchin

  • 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.

Other content recommended for you