“Medical sorting is a reality that the doctor who finds himself forced into it must assume”

Tribune. On the eve of the “third wave” of Covid-19, government spokesman Gabriel Attal said at a press conference on March 31: “Triage of patients is not an option. ” This position is not isolated: many voices are raised to affirm that it is not ethical to “sort” the sick. The company thus takes part in the issue of medical sorting. To be able to fully appreciate this debate, it seems necessary to take an interest in these notions through a historical and philosophical vision of medicine, and to shed light on the reality on the ground.

On March 13, 2020, at the start of the health crisis, the National Consultative Ethics Committee (CCNE) indicated in a press release than, “Respect for the principle of equity being an essential condition for action in a context of scarcity of resources”, he recommended “That the demand for justice, in the sense of egalitarianism, be balanced by the need to prioritize resources”.

Prioritization is thus the proposed answer to the question of distributive justice (aiming at a fair distribution of resources), which is essential in medicine. Medical sorting is its application. Ethical reflections on the subject emerge from the second half of the twentiethe century.

A fully ethical burden

For example, when the first renal dialysis center was opened in 1960 at the Swedish Hospital in Seattle (Washington State), a committee had to be appointed to determine who would be the ten people who would have priority for access this technique of organ replacement, without which the patient dies from complications of end-stage renal disease. Since, “The issues of resource allocation, rationing and triage are now inseparable from costly but increasingly common medical practices” (G. Lachenal, C. Lefève, V.-K .. Nguyen, Sorting Medicine. History, ethics, anthropology, PUF, 2014).

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Indeed, there are many examples of prioritization in medicine today: in organ transplantation, in intensive care or even, at this very moment, during urgent vaccination in an epidemic context! It should all the same be remembered that the principle of equity also undermines the principle of beneficence of the unique conference of the doctor-patient relationship: the patient’s trust in his doctor and the doctor’s loyalty to his patient.

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