Abstract
International Humanitarian Law mandates that all wounded in war, no matter which party they belong to, shall receive aid in accordance with their medical condition, and that “there shall be no distinction among them founded on any grounds other than medical ones.” This principle of impartiality is endorsed by various other military and civilian institutions worldwide to include the ICRC, the US Department of Defense, and the American Medical Association. In this essay, I argue that in some cases, we ought, morally speaking, to triage based on factors beyond one’s medical condition. More specifically, I argue that in these cases, we ought to triage, at least partly, based on one’s moral responsibility for one’s current medical predicament. I call this view Triage by Moral Responsibility (TMR). I support my argument for TMR by demonstrating its plausibility when applied to cases of medical treatment and disaster relief, and by drawing parallels between these situations and those considered in the ethics of defensive harming. I conclude by discussing the practicality of my moral conclusion for the practice of medical triage in pandemics and war.
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Notes
- 1.
I will sometimes drop ‘morally’ for sake of brevity. Other uses of ‘ought’ will be explicitly stated as such. The same is true for other normative terms such as ‘permission,’ ‘wrong,’ ‘responsibility,’ ‘blame,’ etc.
- 2.
I will hereafter simply use ‘actions’ to include omissions.
- 3.
My ‘other things being equal’ clause is meant to hold constant the good that would be produced by treating one vs. another. This would include, among other things, that medical need, effectiveness of treatment, and the number and value of future years of life are the same across patients.
- 4.
I follow Kagan (1997, Ch. 3) in my discussion of this distinction.
- 5.
See Rachels (1975) for one of the most compelling arguments against this moral distinction.
- 6.
See Thomson (1971) for a nice argument that the moral right to life does not imply a right to all those things necessary for living.
- 7.
According to the doctrine of “double effect” (Walzer 1977, Ch. 9), one of these conditions is that the good effects must be proportional to (i.e. outweigh) the bad effects. This is known as proportionality.
- 8.
These percentages are obviously not accurate, but they should still serve to make my point.
- 9.
Recall that on a moderate deontological view, the right to fair access can be permissibly infringed when enough good is at stake.
- 10.
Recall my discussion of doing vs. allowing harm in Sect. 8.4.2.
- 11.
There are exceptions to this, of course. Those who fight on the just side of war can commit war crimes or other morally impermissible actions, which could make them liable to defensive harm and allowed harm in LRSs. I am concerned with the more controversial question of whether just combatants who follow the rules of war (e.g. targeting only combatants) ought to be discriminated against regarding medical care and aid.
- 12.
Recall my discussion in 6.1 on this point.
- 13.
Another possible moral justification, suggested by an anonymous reviewer, for prioritizing treatment of noncombatants over just combatants is that the latter incur a duty to suffer the harm in an LRS by virtue of occupational choice. Tadros (2020, Ch. 11) presents a very plausible version of such a view, but he ultimately rejects it on grounds of fairness. However, I do not think his arguments are decisive.
References
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Woodside, S.N. (2023). Medical Triage by Moral Responsibility in Crisis and War. In: Eagan, S.M., Messelken, D. (eds) Resource Scarcity in Austere Environments. Military and Humanitarian Health Ethics. Springer, Cham. https://doi.org/10.1007/978-3-031-29059-6_8
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