Over the past several months, the virus causing COVID-19 disease has been spreading silently throughout the world, infecting hundreds of thousands of people. COVID-19 already has killed over eighteen thousand people worldwide, and it threatens to hospitalize and kill countless more as well as to overwhelm systems of health care delivery. As the pandemic spreads in breadth and depth, people are beginning to call for programs of triage and rationing of health care. How should Catholic health care professionals and administrators address these issues?
Triage is an organized process of determining the priority of treating patients based on the severity of their condition. Closely linked to triage in times of crisis or during emergency events is rationing, the controlled allocation of medical equipment, services, or resources, including the time and attention of health care professionals.
Health care triage outside war or mass casualty events from accidents, terrorism, or extreme weather has been unusual in the United States. Some guidance for triage in pandemics was developed following the SARS outbreak in 2002–2004 and the H1N1 crisis in 2009. But little research has been done to determine whether this triage guidance leads to optimal outcomes. Implementing strict triage and rationing plans in the context of patient care can raise a number of ethical questions. Patients and families may wonder if they will be abandoned or whether decisions will be based on sound criteria and implemented in a fair and consistent manner. Overburdened health care professionals may suffer moral distress in denying life-saving care to some patients while offering it to others, and they may struggle to make impartial decisions.
Triage and rationing are specific protocols within a larger set of planning initiatives for situations of extreme medical needs and limited resources called “crisis standards of care.” The National Catholic Bioethics Center (NCBC) has utilized materials from several recognized sources on crisis standards of care (listed at the end of this resource), but this resource is focused primarily on the issue of triage and rationing.
The NCBC holds that triage and rationing protocols can be necessary and helpful measures in a pandemic if they are built on sound ethical principles. Catholic health care providers should support sound secular protocols for triage and rationing but also should strive to improve their design and implementation by drawing on resources in the Catholic moral tradition. Below, the NCBC provides some suggested ethical principles, considerations, and questions to assist in this effort.
