# Is civilian hospital triage illegal? **URL:** \ **Category:** Factual Questions\ **Created:** [May 5, 2008, 8:45pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187 "2008-05-05T20:45:28Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![toadspittle](https://avatars.discourse-cdn.com/v4/letter/t/c0e974/32.png) [@toadspittle](https://boards.straightdope.com/u/toadspittle)\ **Post date:** [May 5, 2008, 8:45pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/1 "2008-05-05T20:45:28Z")
Just read an AP article, [“Who should MDs let die in a pandemic? Report offers answers.”](http://news.yahoo.com/s/ap/20080505/ap_on_he_me/pandemic_rationing_care_3) Basically, a task force of doctors has drafted a set of guidelines for hospitals to follow should they need to ration care in a future pandemic. > [@](#): > > Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn’t be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia. OK. It’s something no one wants to have to face, but it’s likely that the medical community will have to make these triage decisions in the future. They already must make them today, on a smaller scale, in crowded ERs, etc. However: > [@](#): > > Public health law expert Lawrence Gostin of Georgetown University called the report an important initiative but also “a political minefield and a legal minefield.” > > The recommendations would probably violate federal laws against age discrimination and disability discrimination, said Gostin, who was not on the task force. > > If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said. While health care rationing will be necessary in a mass disaster, “there are some real ethical concerns here.” On the battlefield, no one thinks twice about triage; casualties happen, and all troops have committed to risking their lives, if necessary. But in the civilian world, is triage even legal? Can you legally deny service to the elderly, the disabled, or the chronically ill, in favor of someone else? What if, in denying service to those with poorly controlled diabetes, say, you wind up disproportionately affecting poor minorities? Does it rise to racial discrimination at that point? ---
**Author:** ![Magiver](https://avatars.discourse-cdn.com/v4/letter/m/4491bb/32.png) [@Magiver](https://boards.straightdope.com/u/Magiver)\ **Post date:** [May 5, 2008, 9:07pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/2 "2008-05-05T21:07:10Z")
You pointed out that it is already done now so I don’t understand your question? If you look at any medical system in place there are benchmarks of denial. In the UK they are denying (some) health care to smokers and the obese. In a pandemic this may extend to social worth. A doctor has value, a person with no jobs skills has a negative value to society. ---
**Author:** ![silenus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/silenus/32/166_2.png) [@silenus](https://boards.straightdope.com/u/silenus)\ **Post date:** [May 5, 2008, 9:14pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/3 "2008-05-05T21:14:16Z")
This will head rapidly off into GD territory, but in a pandemic, triage is the only ethical choice. ---
**Author:** ![friedo](https://avatars.discourse-cdn.com/v4/letter/f/8edcca/32.png) [@friedo](https://boards.straightdope.com/u/friedo)\ **Post date:** [May 5, 2008, 9:27pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/4 "2008-05-05T21:27:26Z")
Every ER already does triage, even on the least exciting days. That dude with the chainsaw wound is going to get treated before your pocket-knife boo-boo, even if he came in after you. A pandemic is no different, it’s just more severe. ---
**Author:** ![Peter\_Morris](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/peter_morris/32/359_2.png) [@Peter\_Morris](https://boards.straightdope.com/u/Peter_Morris)\ **Post date:** [May 5, 2008, 9:38pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/5 "2008-05-05T21:38:47Z")
[QUOTE=friedo] Every ER already does triage, even on the least exciting days. [/quote] Do they? My understanding of triage, which admittedly only comes from watching M_A_S\*H, is that they separate the wounded into three groups: 1) minor 2) serious 3) beyond help. They then leave group 3 to die while they work on group 2. Is that done in civilian hospitals? > [@](#): > > That dude with the chainsaw wound is going to get treated before your pocket-knife boo-boo, even if he came in after you. A pandemic is no different, it’s just more severe. That’s division into 2 groups, not three. Biage? ---
**Author:** ![Antigen](https://avatars.discourse-cdn.com/v4/letter/a/848f3c/32.png) [@Antigen](https://boards.straightdope.com/u/Antigen)\ **Post date:** [May 5, 2008, 9:56pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/6 "2008-05-05T21:56:21Z")
[QUOTE=Peter Morris] That’s division into 2 groups, not three. [/QUOTE] [Triage](http://dictionary.reference.com/browse/triage) doesn’t imply three groups. The “tri” in there is from the french word for “sort”. So “triage” is “sorting”. The number of groups is not specified. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [May 5, 2008, 10:09pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/7 "2008-05-05T22:09:45Z")
[QUOTE=Peter Morris] Do they? My understanding of triage, which admittedly only comes from watching M_A_S\*H, is that they separate the wounded into three groups: 1) minor 2) serious 3) beyond help. They then leave group 3 to die while they work on group 2. Is that done in civilian hospitals? [/quote] If someone comes into the hospital with an untreatable and fatal condition comfort care will be provided (painkillers, for example) but yeah, people “beyond help” do show up occassionally. It makes no sense to potentially torture them with useless procedures (that “first, do no harm” thing). In a civilian disaster I doubt (except under the most extreme circumstances) the dying would be left on the sidewalk but yeah, it’s a real possibility that certain cases would only be given painkillers and otherwise left to die. It’s horrible, but if (hypothetically) you had a situation with no electricity available, mass causalities, and limited medical resources and someone was hauled with burns over 90% of their body… well, I’m sorry, the brutal fact is that even in non-crisis times their chances are crap but without power they’re nil. Better to dope them up with morphine (if you have any) and use your limited resources on, say, people with “only” 10% burns and a couple broken limbs because you might be able to save them - you can’t save the guy with almost no skin left. Each crisis/emergency is different of course. Who would be treated and who might not would have to be decided in the context of whatever is going on and what resources are available. What is ethical under such circumstances is saving as many as you can - that might, indeed, mean you _don’t_ do anything for the hopeless or most severe cases. Nothing personal, just cold reality. ---
**Author:** ![toadspittle](https://avatars.discourse-cdn.com/v4/letter/t/c0e974/32.png) [@toadspittle](https://boards.straightdope.com/u/toadspittle)\ **Post date:** [May 5, 2008, 10:09pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/8 "2008-05-05T22:09:52Z")
[QUOTE=friedo] Every ER already does triage, even on the least exciting days. That dude with the chainsaw wound is going to get treated before your pocket-knife boo-boo, even if he came in after you. A pandemic is no different, it’s just more severe. [/QUOTE] Yes, but do hospitals currently do the sort of triage where it’s: \*There was a 12-car pileup on the highway. The hospital has 10 patients, all of whom need major surgery in the next 2 hours or they will certainly die. The hospital only has the facilities and personnel to treat 5 of them in that time. \* … and so they have to say, “Well, this person is 74 years old–we’ll put them at the end of the line, since they’re old and more likely to die from complications than this 18-year-old. Likewise, this poor black man with diabetes, high blood pressure, and two previous heart attacks is less likely to make a full recovery than is this rich white fellow who–aside from the accident trauma–is in perfect health.” ? In other words, not “this guy’s ax wound gets precedence over your paper cut,” but rather “this guy’s ax wound gets precedence over that other guy’s ax wound.” ---
**Author:** ![Peter\_Morris](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/peter_morris/32/359_2.png) [@Peter\_Morris](https://boards.straightdope.com/u/Peter_Morris)\ **Post date:** [May 5, 2008, 10:12pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/9 "2008-05-05T22:12:30Z")
[QUOTE=Antigen] [Triage](http://dictionary.reference.com/browse/triage) doesn’t imply three groups. [/quote] Ignorance fought. Nevertheless, the question remains. Do civilian hospitals ever leave people to die, without trying to save them? ---
**Author:** ![Kent\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kent_clark/32/105_2.png) [@Kent\_Clark](https://boards.straightdope.com/u/Kent_Clark)\ **Post date:** [May 5, 2008, 10:13pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/10 "2008-05-05T22:13:35Z")
Needing an organ, and even fitting the criteria to get an organ, doesn’t automatically mean you’re getting a transplant. You can spend years working your way up the list only to have the transplant committee determine that someone else has a more immediate need. That’s rationing care by any definition. ---
**Author:** ![bjbrashier](https://avatars.discourse-cdn.com/v4/letter/b/e68b1a/32.png) [@bjbrashier](https://boards.straightdope.com/u/bjbrashier)\ **Post date:** [May 5, 2008, 10:18pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/11 "2008-05-05T22:18:21Z")
As you already answered for yourself, the answer to this question is that no, this kind of triage is not legal under normal circumstances. However, the report is describing abnormal circumstances, and laws can change in such times (“martial law” being an example). Ethically, this is practically a requirement. It’s not nice to let the elderly and infirm die, but it’s nicer than losing far more people due to low resources (any further discussion on this should be in Great Debates). But to even post this as a “good idea” legally, as mentioned, is a “minefield”, since it would NOT be ethical to do this under normal circumstances and most laws are created during such normal circumstances. Legal? Probably not. Going to happen in that kind of instance? Almost certainly. Going to be punished for it? Almost certainly not. If one will not be punished for a crime, one definition of “legal” suggests that this activity is not illegal after all (as many believe with going 5 mph over the speed limit). And yes, certain subgroups (such as races) would be disproportionately affected. ---
**Author:** ![artemis](https://avatars.discourse-cdn.com/v4/letter/a/91b2a8/32.png) [@artemis](https://boards.straightdope.com/u/artemis)\ **Post date:** [May 5, 2008, 10:20pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/12 "2008-05-05T22:20:41Z")
[QUOTE=Peter Morris] Nevertheless, the question remains. Do civilian hospitals ever leave people to die, without trying to save them? [/QUOTE] Yes, in mass casualty situations. Those situations don’t happen often, but when they do, civilian hospitals do perform triage, and for the same reason that battlefield hospitals do: it’s simply impossible to save everyone. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [May 5, 2008, 10:31pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/13 "2008-05-05T22:31:09Z")
[QUOTE=toadspittle] Yes, but do hospitals currently do the sort of triage where it’s: \*There was a 12-car pileup on the highway. The hospital has 10 patients, all of whom need major surgery in the next 2 hours or they will certainly die. The hospital only has the facilities and personnel to treat 5 of them in that time. \* … and so they have to say, “Well, this person is 74 years old–we’ll put them at the end of the line, since they’re old and more likely to die from complications than this 18-year-old. Likewise, this poor black man with diabetes, high blood pressure, and two previous heart attacks is less likely to make a full recovery than is this rich white fellow who–aside from the accident trauma–is in perfect health.” [/QUOTE] Under _normal_ circumstances the receiving hospital sends 5 patients to the OR and calls for a medivac helicopter and/or ambulances to transport the other 5 to other hospitals that can treat them. Under such circumstances the older/sicker patients are probably least likely to be transported as the younger/healthier folks could probably withstand the stress of transport better, but there are all sorts of confounding factors at work in such circumstances. ---
**Author:** ![bump](https://avatars.discourse-cdn.com/v4/letter/b/7c8e57/32.png) [@bump](https://boards.straightdope.com/u/bump)\ **Post date:** [May 5, 2008, 10:39pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/14 "2008-05-05T22:39:30Z")
Flip it around… in case of a major deadly pandemic, is it ethical to treat the classes of people mentioned at the expense of a larger number of healthier people? And, like others have said, this isn’t SOP; it’s in case of a pandemic, which is about as abnormal as things get. ---
**Author:** ![Saint\_Cad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/saint_cad/32/18907_2.png) [@Saint\_Cad](https://boards.straightdope.com/u/Saint_Cad)\ **Post date:** [May 5, 2008, 10:40pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/15 "2008-05-05T22:40:06Z")
As an emergency situation at school we have 4 groups to put students in during triage: Green - no treatment necessary Yellow - serious injury Red - critical Black - dead or no chance for recovery Someone blacktagged will get no treatment even if still alive in favor of red tags ---
**Author:** ![KneadToKnow](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kneadtoknow/32/3999_2.png) [@KneadToKnow](https://boards.straightdope.com/u/KneadToKnow)\ **Post date:** [May 5, 2008, 10:54pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/16 "2008-05-05T22:54:23Z")
I’m being thrown by the use of the term “rationing” in this thread. Rationing care would be “we’ve only got so much antidote, some people are not going to get any and are therefore going to die.” A lot of what is being described in this thread is “prioritizing”: “we’ve only got so many surgeons, some people are going to have to wait for their surgery and _risk dying_ in the meantime.” ---
**Author:** ![Cub\_Mistress](https://avatars.discourse-cdn.com/v4/letter/c/ea666f/32.png) [@Cub\_Mistress](https://boards.straightdope.com/u/Cub_Mistress)\ **Post date:** [May 5, 2008, 11:01pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/17 "2008-05-05T23:01:09Z")
There are two different sorts of triage. Daily, normal triage in a hospital ED is based on the “sickest first” concept. Someone with no heartbeat and no breathing will get everyone’s attention even though he’s dead, really. A twisted ankle might not be seen for several hours, apart from a screening exam. If a hospital ED is overrrun from say, a train wreck, area hospitals and trauma centers would be notified and patients would be sent there, just as\*\* Broomstick\*\* said. Disaster triage is a different kettle of fish. It is based on the “greatest good for the greatest number” concept. People are classified according to breathing, circulation and ability to follow commands (which indicates level of consciousness.) People who are only slightly injured will be seen last, just as before, but people in the middle groups (severely injured but saveable) will be seen first. [Here’s an algorithm that shows what I’m talking about](http://www.remm.nlm.gov/startadult.htm) The basic concept would also apply in a pandemic. ---
**Author:** ![Little\_Plastic\_Ninja](https://avatars.discourse-cdn.com/v4/letter/l/f07891/32.png) [@Little\_Plastic\_Ninja](https://boards.straightdope.com/u/Little_Plastic_Ninja)\ **Post date:** [May 5, 2008, 11:01pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/18 "2008-05-05T23:01:42Z")
[QUOTE=Magiver] In the UK they are denying (some) health care to smokers and the obese. [/QUOTE] Wait. What? This may be a hijack, but what care do they deny to these people? ---
**Author:** ![MikeS](https://avatars.discourse-cdn.com/v4/letter/m/919ad9/32.png) [@MikeS](https://boards.straightdope.com/u/MikeS)\ **Post date:** [May 5, 2008, 11:04pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/19 "2008-05-05T23:04:46Z")
[QUOTE=bjbrashier] Legal? Probably not. Going to happen in that kind of instance? Almost certainly. Going to be punished for it? Almost certainly not. [/QUOTE] No guarantee that a prosecutor won’t try to second-guess the decision after that fact, though; a recent example of this case would be the case of [Anna Pou](http://en.wikipedia.org/wiki/Anna_Pou). Granted, her case was one of active euthanasia (in the aftermath of Katrina) rather than letting someone die via denying them care, but that just means that the doctors might be charged with manslaughter instead of murder. ---
**Author:** ![St.Urho](https://avatars.discourse-cdn.com/v4/letter/s/8e7dd6/32.png) [@St.Urho](https://boards.straightdope.com/u/St.Urho)\ **Post date:** [May 5, 2008, 11:47pm UTC](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187/20 "2008-05-05T23:47:58Z")
[QUOTE=Broomstick] Under _normal_ circumstances the receiving hospital sends 5 patients to the OR and calls for a medivac helicopter and/or ambulances to transport the other 5 to other hospitals that can treat them. Under such circumstances the older/sicker patients are probably least likely to be transported as the younger/healthier folks could probably withstand the stress of transport better, but there are all sorts of confounding factors at work in such circumstances. [/QUOTE] Actually, under normal circumstances, the ambulance service should be working with the hospitals to figure out who can take what. We even do this on larger car accidents- if I have, say, 4 critical patients and 2 walking wounded patients I’ll notify my dispatch center. Then I have them call the local trauma centers and figure who can take how many of each patient. As far as triage go, most places are using START Triage- you can see the algorithm [here.](http://www.citmt.org/start/flowchart.htm) St. Urho Paramedic [Next page](https://boards.straightdope.com/t/is-civilian-hospital-triage-illegal/448187.md?page=2)