Scarcity, harm, and the circumstances of justice: when does triage truly become problematic?

Abstract

Triages are not ordinarily problematic. They are only problematic when the decision involves an unequal distribution of resources with significant harm to someone; Under normal circumstances, triage simply ensures better efficiency in resource management without causing significant harm to anyone. However, there are critical and dramatic situations in which it is not possible to provide the same service to everyone at the same time without leaving someone in a harmful situation. In ordinary situations, it is necessary to establish priorities that guarantee efficient prioritization (maximum effectiveness at the lowest cost) in a fair way. In these circumstances, there is no “triage problem” because even if someone is at a disadvantage relative to another, the disadvantage is not significant or impossible to compensate for. A triage problem arises when it is necessary to ration the resource, creating a significant burden for some party that cannot be compensated. In the case of decisions about the priorities for using ICU resources in the recent pandemic, the decisions seemed to imply accepting that someone could receive worse treatment, with a serious risk of death or harm, due to the omission of the best treatment available only to some. In this article, I intend to investigate whether the consequentialist approach that supposedly appears to underlie proposals for the problem of triage in the distribution of mechanical ventilators to patients seriously affected by COVID-19 can be evaluated in light of a better interpretation of the so-called harm principle. But why do we think it is right to allocate scarce vital resources to increase the chance of saving more people in some circumstances, but are reluctant to accept it as right to follow this same principle in other situations? For example, would it be correct to redistribute vital resources already allocated to guarantee the consequentialist principle of the best aggregate result of more lives saved? I intend to evaluate why it is right to give an ICU bed to someone who is more likely to survive before allocation, but wrong to apply this same principle to remove someone from that bed after the allocation has been made. The study will allow us to develop a concept of harm that is capable of reflectively balancing the intuitions and principles at play.