Too old to save? COVID-19 and age-based allocation of lifesaving medical care.

Abstract

Adults aged 65 and over are disproportionately impacted by the coronavirus disease 2019 (COVID‐19) pandemic and represent by far the largest share of severe disease and death. This paper critically examines ethical arguments for using implicit and explicit age criteria as a standard for allocating scarce lifesaving resources during the pandemic. Section 1 introduces the topic. Section 2 distinguishes standard from pandemic triage. Section 3 assesses ethical arguments for criteria that are implicitly age‐based, including quality‐adjusted life years, disability adjusted‐life years, and total number of future life years. Section 4 examines ethical arguments for criteria that are more directly age‐based, including fair innings, equality between old and young, and priority to the worse off. The paper concludes that neither implicit nor explicit age‐based allocation withstands careful scrutiny.