Omicron is raising cruel issue of triage

At some point after he became chief surgeon in Napoleon’s army, Dominique Jean Larrey started walking across blood-soaked battlefields to pick out those among the wounded who could still be saved, usually by instant amputation of limbs. In time, he developed a system of sorting and separating — trier in French — the casualties. Ignoring rank and nationality, he considered only those who had the greatest chance of surviving. His method became known as triage.
In worst-case scenarios, triage is nowadays accepted almost universally as necessary and justified. And yet, the idea still rests on an act of cruelty — cruel both to a victim and to the doctor having to make the decision. It often necessitates allowing one human being to die in order to ration the care that might let another live.
The current pandemic is a worst-case scenario. On-and-off for almost two years, doctors and nurses in some places have had to make traumatising choices about life and death. Sometimes they had too many Covid patients for too few ventilators; other times too many with Sars-CoV-2 to be able to treat those dying from cancer or other diseases. Now the Omicron variant — which appears to be somewhat milder but much more infectious — threatens to overwhelm hospitals yet again.
Under existing guidelines in Germany, issued by a medical association, disabilities should in theory be irrelevant during triage — as is the case with age, sex or ethnicity. The only thing that matters is whether one individual patient in a specific situation with a specific ailment stands a better chance of being saved than another.
In practice, however, doctors under pressure are apt to view the frailties of disabled people as “comorbidities,” and thus relevant. Nancy Poser, one of the plaintiffs, explained the situation this way: If she had a heart attack and showed up in the hospital in her wheelchair, she’d get a worse triage score than a smoker simultaneously arriving with Covid-19. He’d get a bed; she wouldn’t. She “would have to die, exactly that.”
As the discussions heat up, some pundits are already demanding making triage more fair overall. There’s danger in that goal. We can’t agree on what’s “fair” even in other policy areas, such as taxation, and certainly won’t in this context.
The German parliament and other legislatures should clarify that the allocation of scarce medical care must be based solely on the merits of each individual case and the relative likelihood of success, always with the goal of maximising lives saved. Only medical staff can make these decisions.
—Bloomberg
But to ensure that even under pressure and ambiguity no discrimination takes place, parliament could require doctors to seek additional and independent opinions — perhaps from a medical board that can be contacted around the clock. This would add bureaucracy, but might prevent some bad calls.
That leaves the thorny issue of those unwilling to get vaccinated. Triage is not the place to deal with it. But society is justified in trying to prevent the worst-case scenarios that lead to triage in the first place. Provided shots can be made available to all, democratically elected legislatures are therefore well within their rights to mandate vaccination.

—Bloomberg