Unto the least of these: Caring for the vulnerable in the time of COVID

Abstract

As the COVID-19 pandemic initially unfolded in early 2020, medical systems were rapidly overwhelmed with critically ill patients. Intensive care resources were strained and, in some cases, insufficient. Concepts of triage and allocation of life-saving resources, once only hypothetical, were called into action. Vulnerable elderly, chronically ill, and disabled patients found themselves subject to protocols and guidelines that singled them out for disparate access to treatments. In this article, I overview the historical background of the early COVID-19 crisis, frontline triage guidelines in Italy and New York City, the conceptual nature of triage, the problematic practice of reallocation, the ethical principles that were challenged, how Judeo-Christian teachings inform these issues, and conflicts of physician duties with attendant moral distress. I close with a set of normative guideline statements that could help define a path through the extreme scarcities of a catastrophic pandemic crisis surge.