Ethical aspects of triage in mass casualty

There is a growing awareness that, not only in war, but also in relation to natural disasters, we may have to face situations of mass casualty. Little has been said about the philosophical aspects of the triage problem arising in anesthesiology in these circumstances, however. There are only a few articles where these problems are addressed in a fruitful manner. These articles are reviewed here.

Even though important triage problems have been identified in the recent literature, they have not been solved in the discussion. Furthermore, there is no unanimity about how they should be solved in principle or in practice.

The implications of the discussions reviewed here are mainly for policy making and only indirectly for the clinic. When the problems have been sorted out in the political process, however, one would hope that a result should surface in the form of clear guidelines for clinical application. One of the reviewed articles puts forward suggestions to this effect. This, however, could only be the beginning of an important discussion to come.