Triage Ethics

We have catastrophe on the mind--a society wide disaster that will severely tax resources, including medical care. Such a catastrophe might be pandemic flu or a terrorist attack.

The medical community is drawing up emergency plans to meet such catastrophes, using the battlefield principles of triage. Triage divides the injured into three groups: 1) those for whom immediate care will save lives, 2) those who can wait for care and will probably survive, and 3) those with the severest injuries, whose survival is least likely. The third group also includes individuals who fall into undervalued categories, such as the most aged. Medical care is not first come first served, but in the order of group 1, group 2, and finally group 3. In extreme circumstances group 3 may never get care.

Ethiticists justify triage on the grounds of maximizing the survivors, while best using limited resources. In May the American College of Chest Physicians issued a report in their magazine "Chest" that declared, "If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing."

Among those in the triage bottom third are (as summarized by CNN) people older than 85; those with severe trauma, which could include critical injuries from car crashes and shootings; severely burned patients older than 60; those with severe mental impairment, which could include advanced Alzheimer's disease; and those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

In my estimation this and the many similar reports (including a recent 1900 page California document) has had insufficient attention rather than say the likes of gay marriage with which society is obsessed. Triage causes us to consider both the essential and the contextual value of life. For example, relative youth trumps advanced age.

A thoughtful conversation about triage ethics might make us all more compassionate and understanding of what really matters when it comes to the human co0ndition.