The Ethical Triage Dilemma: Who Should Receive Medical Care First; Is This the Right Question?

• Published date: 01 June 2023
• Author: Alessandro Ferrara
• Date: 01 June 2023
• DOI: http://doi.org/10.1111/raju.12376

Ratio Juris. Vol. 36 No. 2 June (178–190)

© 2023 The Author. Ratio Juris published by University of Bologna and John Wiley & Sons Ltd.

The Ethical Triage Dilemma:

Who Should Receive Medical Care First;

Is This the Right Question?

ALESSANDRO FERRARA

Abstract. In 2020, with the outbreak of the COVID- 19 pandemic, academics and scientists began

to question the triage criteria for allocating insufficient healthcare resources, trying to ethically

justify the answer to the question, Who should receive medical care first? In this article, I will

argue that even if we apply triage criteria, we won’t be able to avoid the violation of human

dignity or of the right to life and to health care. I will then suggest that, maybe, the real ethical

triage dilemma lies not in the question, Who should receive medical care first? but in the ques-

tion, How are we to decide who should receive medical care first?

1. Introduction

On March 11, 2020, the outbreak of COVID- 19 was recognized as a pandemic af-

fecting the whole world (WHO2020), showing that even the most advanced health

systems can be hit hard during a health emergency of this magnitude. In fact, the dif-

ferent approaches adopted by governments to deal with the pandemic did not make

a real difference in containing the spread of the disease.

The first wave of the pandemic (which stretched from March to May 2020) showed

that health systems were barely prepared to face a disproportionate demand for in-

tensive care beds and ventilators. The agony of the intensive care unit (ICU) and the

wards, and the difficulty of managing hospitalization, led physicians and associa-

tions to independently identify criteria for allocating the scarce resources they had.1

At the same time, most of the national and supranational ethics committees expressed

different opinions on the issue, identifying the fundamental rights that must be

1 See Vergano et al.2020, with the Società Italiana Anestesia, Analgesia, Rianimazione e Terapia

Intensiva (SIAARTI); Meyfroidt et al.2020, with the Belgian Society of Intensive Care Medicine

(SIZ Medica); Berlinger et al.2020, with The Hastings Center; and Rascado Sedes et al. 2020,

with the Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC)

and the Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). See also

Comité de Bioética de España (CBE 2020); Nuffield Council on Bioethics2020; and the Irish

Department of Health (An Roinn Sláinte 2020). Other national bioethics councils have issued

broad policy statements on the question of the COVID- 19 response— see, e.g., SFAR 2020 (in

France); Marckmann et al.2020 (Germany); and ARGE Ethik ÖGARI 2020 (Austria)— as have

the UNESCO International Bioethics Committee and the UNESCO World Commission on the

Ethics of Scientific Knowledge and Technology (IBC and COMEST 2020).

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