Point: Is considering social determinants of health ethically permissible for fair allocation of critical care resources during the covid-19 pandemic? Yes

There is growing agreement that triage protocols for scarce medical resources such as ICU beds and ventilators should—at the very least—not exacerbate the profound disparities in health outcomes that are occurring during the COVID-19 pandemic among racial or ethnic minorities, persons with disabilities, and low-income people. Some have suggested that ICU triage guided solely by medical prognosis (ie, chances of survival to hospital discharge) will accomplish this. Although pure prognosis-based triage may seem equitable, it is not; it would exacerbate health disparities that have become a national priority to mitigate. Counterintuitively, this would be the case even if there were no differences in medical prognoses among hospitalized patients according to race or other forms of social disadvantage. Therefore, if we take seriously the commitment to fairness in triage, we cannot rely solely on prognosis-based triage. To show equal respect for all members of society, we must take steps to lessen the extent to which disadvantaged people are further disadvantaged by triage processes.