Editing Triage (section)

== Ethical considerations ==
Because treatment is intentionally delayed or withheld from individuals under this system, triage has ethical implications that complicate the decision-making process. Individuals involved in triage must take a comprehensive view of the process to ensure fidelity, veracity, justice, autonomy, and beneficence are safeguarded.<ref name="pmid16001601">{{cite journal | vauthors = Repine TB, Lisagor P, Cohen DJ | title = The dynamics and ethics of triage: rationing care in hard times | journal = Military Medicine | volume = 170 | issue = 6 | pages = 505–509 | date = June 2005 | pmid = 16001601 | doi = 10.7205/milmed.170.6.505 }}</ref>

Ethical implications vary between different settings and the type of triage system employed, culminating in no single gold-standard approach to triage. Emergency departments are advised to preemptively plan strategies in attempts to mitigate the emotional burden on these triage responders.<ref>{{cite journal | vauthors = Hick JL, Hanfling D, Cantrill SV | title = Allocating scarce resources in disasters: emergency department principles | journal = Annals of Emergency Medicine | volume = 59 | issue = 3 | pages = 177–187 | date = March 2012 | pmid = 21855170 | doi = 10.1016/j.annemergmed.2011.06.012 | doi-access = free }}</ref> While doing so, [[standards of care]] must be maintained to preserve the safety of both patients and providers.

There is widespread agreement among [[ethicist]]s that, in practice, during the [[COVID-19 pandemic]] triage should prioritize "those who have the best chance of surviving" and follow guidelines with strict criteria that consider both short-term and long-term survivability.<ref>{{cite journal | vauthors = Joebges S, Biller-Andorno N | title = Ethics guidelines on COVID-19 triage-an emerging international consensus | journal = Critical Care | volume = 24 | issue = 1 | pages = 201 | date = May 2020 | pmid = 32375855 | pmc = 7202791 | doi = 10.1186/s13054-020-02927-1 | doi-access = free }}</ref> Likewise, the triage of other health services has been adjusted during the pandemic to limit resource strain on hospitals.

=== Utilitarian approach and critique ===
Under the utilitarian model, triage works to maximize the survival outcomes of the most people possible. This approach implies that some individuals may likely suffer or die, in order for the majority to survive. Triage officers must allocate limited resources and weigh an individual's needs along with the needs of the population as a whole.

Some ethicists argue the utilitarian approach to triage is not an impartial mechanism, but rather a partial one that fails to address the social conditions that prevent optimal outcomes in marginalized communities, rendering it a practical but inadequate means of distributing health resources.<ref name="pmid29933511">{{cite journal | vauthors = Okorie N | title = Partiality, impartiality and the ethics of triage | journal = Developing World Bioethics | volume = 19 | issue = 2 | pages = 76–85 | date = June 2019 | pmid = 29933511 | doi = 10.1111/dewb.12201 | s2cid = 49387832 }}</ref>

=== Special population groups ===
There is wide discussion regarding how VIPs and celebrities should be cared for in the emergency department. It is generally argued that giving special considerations or deviating from the standard [[Medical guideline|medical protocol]] for VIPs or celebrities is unethical due to the cost to others. However, others argue that it may be morally justifiable as long as their treatment does not hinder the needs of others after assessing overall fairness, quality of care, privacy, and other ethical implications.<ref>{{cite journal | vauthors = Geiderman JM, Malik S, McCarthy JJ, Jagoda A | title = The care of VIPs in the emergency department: Triage, treatment and ethics | journal = The American Journal of Emergency Medicine | volume = 36 | issue = 10 | pages = 1881–1885 | date = October 2018 | pmid = 30238911 | doi = 10.1016/j.ajem.2018.07.009 | s2cid = 52310367 }}{{Dead link|date=October 2019 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>

=== Proposed frameworks in conflict ===
A variety of logistical challenges complicate the triage and ultimate provision of care in conflict situations. Humanitarian actors acknowledge challenges like disruptions in food and medical supply chains, lack of suitable facilities, and existence of policies that prohibit administration of care to certain communities and populations as elements that directly impede the successful delivery of care.<ref name = "Broussard_2019" /> The logistical realities of humanitarian emergencies and conflict situations threatens the bioethical principle of beneficence, the obligation to act for the benefit of others.<ref name = "Broussard_2019">{{Cite journal| vauthors = Broussard G, Rubenstein LS, Robinson C, Maziak W, Gilbert SZ, DeCamp M |date=2019-09-05|title=Challenges to ethical obligations and humanitarian principles in conflict settings: a systematic review|journal=Journal of International Humanitarian Action|volume=4|issue=1|pages=15|doi=10.1186/s41018-019-0063-x|s2cid=201838587|issn=2364-3404|doi-access=free}}</ref>

=== Technical challenges of triage in conflict settings ===
To address the ethical concerns that underpin triage in conflict situations and [[humanitarian crises]], new triage frameworks and classification systems have been suggested that aim to uphold [[human rights]]. Scholars have argued that new frameworks must prioritize informed consent and rely on established medical criteria only in order to respect the human rights considerations set forth by the [[Geneva Convention]] of 1864 and the [[Universal Declaration of Human Rights]],<ref name="pmid11367943">{{cite journal | vauthors = Domres B, Koch M, Manger A, Becker HD | title = Ethics and triage | journal = Prehospital and Disaster Medicine | volume = 16 | issue = 1 | pages = 53–58 | date = 2001 | pmid = 11367943 | doi = 10.1017/s1049023x00025590 | s2cid = 36211479 }}</ref> but no comprehensive triage model has been adopted by international bodies.

=== Veterinary triage===
[[Veterinarian|Emergency veterinarian]] Jessica Fragola wrote in 2022 about the ethics of animal triage. She said that pressures on veterinarians having been exacerbated by staffing shortages that resulted from the COVID-19 pandemic, coupled with growth in spending on [[veterinary care]] and on [[pet insurance]].<ref>{{Cite web|url=https://www.newsday.com/opinion/commentary/pet-care-veterinary-care-animal-er-p06697|title=Pets need vets: Be kind to both|website=Newsday|date=February 7, 2022| vauthors = Fragola J }}</ref>