Triage and Equality: An Historical Reassessment of Utilitarian Analyses of Triage

Abstract

function is the objective. The more difficult cases wait, regardless of the seriousness of their need.Theologian Paul Ramsey pointed out some years ago that military or disaster triage has a clear objective: to save the most salvageable so that they can contribute to the common goodÂ-which, in battle, is victory; in earth-quake or fire, is public safety. The common good provides the criterion for selection. According to Jonsen, then, the practice Larrey dubbed "triage" was a utilitarian allocation scheme designed to save the most salvageable patients in order to provide for the common good. Standard treatments of the subject substantially agree with the Engelhardt-Jonsen-Ramsey account.Cementing this view of triage in the minds of most scholars is the wellknown and vivid first-hand account of penicillin triage during World War II penned by Dr. Henry Beecher:When the wonders of penicillin were new, but recognized, and the supply heartbreakingly meager, a small shipment finally arrived in North Africa during World War II. The hospital beds were overflowing with wounded men. Many had been wounded in battles; many also had been wounded in brothels. Which group would get the penicillin? By all that is just, it would go to the heroes who had risked their lives, who were still in jeopardy, and some of whom were dying. They did not receive it, nor should they have; it was given to those infected in brothels. Before indignation takes over, let us examine the situation.First, there were desperate shortages of manpower at the front. Second, those with broken bodies and broken bones would not be swiftly restored to the battle line, even with penicillin, whereas those with venereal disease, on being

Triage of intensive care patients: identifying agreement and controversy

“…Whether such an approach is compatible with other views of distributive justice is more a matter of contention. Baker and Strosberg [28] argued that a triage scheme that prioritizes those individuals who are most likely to benefit has some egalitarian justification. The diminished endorsement of obligations to patients already hospitalized in the current consensus compared to the SCCM consensus may also be a function of new developments and understanding of the importance of triage.…”

Public Health Ethics: Cases Spanning the Globe

“…Critics of utilitariani sm reply that it requires coercion or covertness to succeed, because the public will not voluntarily sacrifi ce their lives or their loved ones for the greater good (Baker and Strosberg 1992 ). Utilitarian triage may be unpalatable to the public on the further ground that it quantifi es and judges the value of one life over another, which could disproportionally impact particular population groups (Hoffman 2009 ).…”

“…Utilitarian triage may be unpalatable to the public on the further ground that it quantifi es and judges the value of one life over another, which could disproportionally impact particular population groups (Hoffman 2009 ). Others therefore would base triage decisions on egalitarian considerations, for instance, by giving everyone an equal chance at obtaining a scarce good, an approach for which historical precedent exists (Baker and Strosberg 1992 ).…”

Rationing in the intensive care unit

“…That physicians are already acting as dual agents, and simply not letting patients know, hardly seems a viable solution to the problem of abandonment. Instead, educating patients and surrogates about both the reasons for rationing (11,14,15,49,50) and the fair policies by which these decisions are made may help set realistic expectations and promote trust, thereby reducing patients' susceptibilities to feeling abandoned.…”