More Info
									Vol. 25:1 Spring 2009

ethical DileMMas in triage:
a PersPective froM the JeWish
PhilosoPhical traDition
D . M . S . B O D A N S K Y, B M E D S C ( N E U R O S C I E N C E )

Triage is a system for deciding which patient to treat first in an acute setting. It divides
patients into three groups: those who can wait, those who can be saved with timely
treatment and those unlikely to survive despite treatment. This article examines the
Jewish ethical perspective on triage as the basis for a clinician’s moral approach and
to see whether it is concordant with current UK procedure. The Jewish view prioritises
patients firstly according to the seriousness of their condition and the ability to save
their life. This is broadly similar to usual triage practice. Then, according to the Jewish
view, if two patients have similar levels of clinical need, they would be seen on a ‘ first
come, first served’ basis. After that, the degree of kinship to the doctor is considered and
lastly the patient’s social worth. Age is not a factor that is utilised for prioritisation. The
Jewish view of triage is therefore based not only on clinical priorities but also considers
additional social issues. This approach provides additional layers of prioritisation
based on moral factors for the clinician, beyond the simple three levels of need used to
triage acute patients.

It is :00 a.m. in a small general district hospital in the North of Scotland. It has been a
slow night in the hospital’s Accident and Emergency (A&E). Suddenly, the phone goes,
informing you, the doctor on duty, that there has been a serious car crash. Two patients,
both badly injured and both requiring immediate surgery are on their way and will arrive
shortly. To your dismay, you realise that with the personnel and facilities available, you
will only be able to operate on one, leaving the other to die.
     This article analyses and explains triage and attempts to answer some contemporary
ethical questions concerning the practice and application of triage by recourse to
traditional Jewish, rabbinic, thought. I use the above example to illustrate the problems
involved but use other examples for specific principles. I discuss resource allocation
within a wider setting and then focus on triage more specifically. I compare the
traditional Jewish view with the procedure used by UK hospitals, to see whether they
are compatible or whether there are areas of conflict. There are several questions that I
intend to resolve: How can a doctor choose between two patients? What are the criteria
that one must consider and utilise to make one’s choice? Which take precedence? And
finally, which patients come first, all else being equal? The system used to help make
these decisions is called ‘triage’.

     EthicS & MEdicinE

To top