Abstract
Triage is the selection of some people in need of care from a larger group of needy people. This entry focuses on mass casualty circumstances (war and civilian disasters) in which a healthcare team with limited resources must choose who should become a patient and who remains outside its reach of care.
The fundamental values of military triage, international humanitarian law, and humanitarianism values are equality and priority to “medical urgency.” However, the circumstances, resources, type of care team, and other factors might bear on the planning and execution of triage.
Whereas maximization of life saved, health promoted, and suffering reduced is the ultimate goal of healthcare, especially in disaster settings, only utilitarians are committed only to these goals alone.
Most authors behold mass emergencies as justification for increased utilitarian considerations (but not necessarily purely utilitarian ethics). However, lack of scientific evidence undermines the validity of many utilitarian schemes of triage schemes. This obscurity is a risk factor for all sorts of bias. Hence, much of the ethics of triage depend on formal, rather than substantial, factors. This means that emphasis is given to structures and style of reasoning, execution, and revision.
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References
Barilan, Y. M., Brusa, M., & Halpern, P. (2014). Triage in disaster medicine: Ethical strategies in various scenarios. In B. Gordijn, D. O’Mathuna, & R. Macklin (Eds.), Ethics in disaster medicine (pp. 49–64). Dordrecht: Springer.
Eyal, N., & Firth, P. (2012). Repeat triage in disaster relief: Questions from Haiti. PLOS Current Disasters. doi:10.1371/4fbbdec6279ec.
Gross, M. (2006). Bioethics in armed conflict. Cambridge, MA: MIT Press.
ICRC. (2006). Non-discrimination. Customary International Humanitarian Law. https://www.icrc.org/customary-ihl/eng/docs/v1_rul_rule88#Fn_4_1.
Iserson, L., & Moskop, J. V. (2007). Triage in medicine, part I: Concept, history, and types. Annals of Emergency Medicine, 49, 275–281.
WMA. (2006). World Medical Association’s statement on ethics on medical ethics in the events of disasters. http://www.wma.net/en/30publications/10policies/d7/.
Further Readings
Burris, D., Welling, D., & Rich, N. M. (2004). Dominique Jean Larrey and the principles of humanity in warfare. Journal of the American College of Surgery, 198, 832–835.
Moskop, J. V., & Iserson, L. (2007). Triage in medicine, part II: Underlying values and principles. Annals of Emergency Medicine, 49, 282–287.
Robertson-Steel, I. (2006). Evolution of triage systems. Emergency Medical Journal, 23, 154–155.
Winslow, G. R. (1982). Triage and Justice. Berkeley: University of California Press.
Acknowledgment
The authors are part of EU program COST IS1201, ethics in disaster medicine.
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Barilan, Y.M., Brusa, M. (2016). Triage. In: ten Have, H. (eds) Encyclopedia of Global Bioethics. Springer, Cham. https://doi.org/10.1007/978-3-319-09483-0_425
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DOI: https://doi.org/10.1007/978-3-319-09483-0_425
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