"Playing God": Analyzing the Bioethics of Triage from Hurricane Katrina and Haiti's Earthquake to Covid-19

Abstract

As the world experiences more mass-casualty incidents, such as extreme weather events or pandemics, health systems are put under pressure to treat those in need, generating the problem of scarcity of vital resources. The allocation of scarce resources is done via triage, the assigning of priority order to persons on the basis of where resources can be best used, are most needed, or are most likely to achieve success. This article analyzes the ethics of three potential triage models—the survival model, social worth model, and lottery model—as a means of assessing the benefits and drawbacks of the models in relation to the United States healthcare system. Hurricane Katrina, the 2010 Haiti earthquake, and COVID-19 are utilized as case studies to present success and failures of implementation of existing triage models, focusing on how models trade off between efficacy and efficiency. While the initial intent of this research was to determine if there is a superior form of triage that should be adopted to maximize health for U.S. communities in the face of future disasters, as a result of analyses conducted with health and ethics experts, it is apparent that superiority is not the answer. Instead, triage should be treated as a complex and changing system, one that should be evaluated on a case-by-case basis by different providers to create the most optimal solutions.