Bioethics
Online ISSN : 2189-695X
Print ISSN : 1343-4063
ISSN-L : 1343-4063
Articles
The Maximin Rule under the COVID-19 Pandemic
A Thought Experiment with Expanded Triage Model
Jun TOKUNAGA
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2022 Volume 32 Issue 1 Pages 21-29

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Abstract

    The COVID-19 pandemic has triggered a debate on whether triage constitutes discrimination. From the standpoint of consequentialism, the theory of triage, which determines the priority of lifesaving measures, leads to the conclusion that patients with a high chance of survival should be prioritized, without simultaneously discriminating against the elderly or patients with underlying diseases. Based on the rule of maximizing the number of lives saved, it is easy to form a consensus that is useful in guiding medical practice. However, existing theories disregard the role of politics and do not consider the variability of medical resources under the pandemic, thereby resulting in a kind of fallacy of composition concealing the discrimination caused by inadequate infection control. Triage in the pandemic is political and requires a different theoretical framework than the one for disasters or accidents. In this paper, we attempt to develop a expanded theoretical model that deals with triage for the entire region, while considering the medical system from the perspective of the mildly ill to the severely ill as well as the time required for its preparation. The purpose of this paper is to explore the landing point of the controversy over discrimination by conducting a thought experiment within the framework of consequentialism. In short, when the principle of maximizing the number of lives saved is thoroughly applied at the regional level, the expansion of medical resources based on the maximin rule, which prioritizes the vulnerable, becomes the most important ethical requirement. Ensuring the preservation of life under a pandemic is consistent with the vision of justice emphasizing equality.

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2022 Japan Association for Bioethics
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