Article Text

Download PDFPDF

Promoting racial equity in COVID-19 resource allocation
  1. Lori Bruce1,2,3,
  2. Ruth Tallman3,4
  1. 1 Interdisciplinary Center for Bioethics, Yale University, New Haven, Connecticut, USA
  2. 2 Bioethics Program (joint program with Clarkson University), Mount Sinai School of Medicine, Schenectady, New York, USA
  3. 3 Sherwin B Nuland Summer Institute in Bioethics, Yale University, New Haven, Connecticut, USA
  4. 4 Art, Art History, Humanities, Music, Philosophy, Political Science, and Religion, Hillsborough Community College–Dale Mabry Campus, Tampa, Florida, USA
  1. Correspondence to Lori Bruce, Interdisciplinary Center for Bioethics, Yale University, New Haven, CT 06511, USA; Lori.Bruce{at}


Due to COVID-19’s strain on health systems across the globe, triage protocols determine how to allocate scarce medical resources with the worthy goal of maximising the number of lives saved. However, due to racial biases and long-standing health inequities, the common method of ranking patients based on impersonal numeric representations of their morbidity is associated with disproportionately pronounced racial disparities. In response, policymakers have issued statements of solidarity. However, translating support into responsive COVID-19 policy is rife with complexity. Triage does not easily lend itself to race-based exceptions. Reordering triage queues based on an individual patient’s racial affiliation has been considered but may be divisive and difficult to implement. And while COVID-19 hospital policies may be presented as rigidly focused on saving the most lives, many make exceptions for those deemed worthy by policymakers such as front-line healthcare workers, older physicians, pregnant women and patients with disabilities. These exceptions demonstrate creativity and ingenuity—hallmarks of policymakers’ abilities to flexibly respond to urgent societal concerns—which should also be extended to patients of colour. This paper dismantles common arguments against the confrontation of racial inequity within COVID-19 triage protocols, highlights concerns related to existing proposals and proposes a new paradigm to increase equity when allocating scarce COVID-19 resources.

  • clinical ethics
  • distributive justice
  • health care for specific diseases/groups
  • minorities
  • COVID-19

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.


  • Contributors The initially submitted draft was created solely by the corresponding author. The revised drafts were completed by both authors. Both authors participated in the revised versions’ design, analysis and interpretation. Both authors drafted and revised for critically important intellectual content. Both authors gave final approval of the version to be published and agree to be accountable for all aspects of the work related to accuracy and integrity.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • 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