Ethical Challenges of Triage: Natural Law versus Utilitarianism

Authors

1 PhD student in Moral Philosophy, University of Qom

2 Associate Professor, University of Qom, Department of Moral Philosophy

Abstract

Triage in clinical medicine is commonly defined as the process of prioritizing patients when resources are scarce—a process typically interpreted through the lens of maximizing outcomes. This article, employing a philosophical–analytical approach, challenges the prevailing assumption and argues that the normative logic of triage is not necessarily reducible to utilitarianism. The methodology draws on conceptual analysis, examination of core principles in bioethics, and normative interpretation of standard decision-making scenarios in emergency settings. The findings indicate that the internal structure of triage aligns more closely with natural law theory. This is because triage decisions consider not only clinical outcomes (such as the probability of survival) but also the clinician’s intention, the moral limits of action, and the intrinsic value of human life. Case-based analysis of difficult triage decisions shows that many of them can be coherently explained only through the principle of double effect, which distinguishes between intended harms and unavoidable side-effects in moral evaluation. The study concludes that triage can be interpreted consistently within a natural-law framework—a perspective that highlights the need to revise policy guidelines and clinical-ethics training to enhance both theoretical coherence and practical decision-making in crisis conditions.

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References

  1. منابع

    1. وست، هنری (۱۳۹۲). پیامد‌گرایی. در دانشنامۀ فلسفۀ اخلاق (پل. ادواردز؛ دونالد. ام. بورچرت، ویراستاران). (مترجم: انشاءالله رحمتی، صص ۲۴۹–۲۵۳). تهران: سوفیا.
    2. اسمارت، جی. جی. سی. (۱۳۹۲). فایده‌گرایی. در دانشنامۀ فلسفۀ اخلاق (پل. ادواردز؛ دونالد. ام. بورچرت، ویراستاران). (مترجم: انشاءالله رحمتی، صص ۲۶۱–۲۷۶). تهران: سوفیا.
    3. مهدوی‌نژاد، محمدحسین؛ زارع‌گنجارودی، مرتضی. (139۴). پشیمانی اخلاقی: بررسی فلسفی و روان‌شناختی. پژوهش‌های مابعدالطبیعی، 2(1)، صص 11۵–13۶.
    4. Aquinas, T. (1997). Summa Theologica (F. McDermott, Trans.). Christian Classics. (Original work published ca. 1274)
    5. Briggs, S. M., Cherian, D. T. & Rosales, A. C. (2023). Medical response to disasters. In J. Chambers (Ed.), Field guide to global health & disaster medicine (pp. 347-356). Elsevier. https://doi.org/10.1016/B978-0-323-79412-1.00015-1
    6. Ghanbari, V., Ardalan, A., Zareiyan, A., Nejati, A., Hanfling, D. & Bagheri, A. (2020). Ethical prioritization of patients during disaster triage: A systematic review of current evidence. Disaster Medicine and Public Health Preparedness, 14(2), pp. 171-181. https://doi.org/10.1017/dmp.2019.131
    7. Watt, Helen (2005). Beyond Double Effect: Side-Effects and Bodily Harm. In Principles and Cases in Medical Ethics, Chapter 10. Oxford: Oxford University Press.
    8. Miller, D. (2012). Rule utilitarianism. In P. Cripps & J. Millgram (Eds.), The Cambridge Companion to Utilitarianism (pp. 146–165). Cambridge University Press. https://doi.org/10.1017/CCO9781139096737.008
    9. Murphy, M. C. (2011). Intention, foresight and success. In D. S. Oderberg & T. Chappell (Eds.), Human values: New essays on ethics and natural law (pp. 252–266). Routledge.
    10. Tollefsen, C. (2004). Basic goods, practical insight and external reasons. In D. S. Oderberg & T. Chappell (Eds.), Human values: New essays on ethics and natural law. (pp. 32 –51). Palgrave Macmillan.
    11. Simões, M. C. (2013). Hare’s preference utilitarianism. Trans/Form/Ação, Marília, 36(2), pp. 123–134. https://doi.org/10.1590/S0101-31732013000200008
    12. Stuchlik, J. (2022). Intention and wrongdoing: In defense of double effect. Cambridge University Press. https://doi.org/10.1017/9781009030410
    13. Vearrier, L. & Henderson, C. M. (2021). Utilitarian principlism as a framework for crisis healthcare ethics. Springer Nature. https://doi.org/10.1007/s10730-020-09400-2
    14. West, H. R. (2000). An introduction to Mill’s utilitarian ethics. Macalester College.
    15. Woodward (2001). The Philosophers' Debate: A Controversial Moral Principle. University of Notre Dame Press.
    16. Yancey, C. C. & O'Rourke, M. C. (2025). Emergency department triage. In StatPearls [Internet]. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557583/

     

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History

  • Receive Date: 15 August 2025
  • Revise Date: 29 November 2025
  • Accept Date: 02 December 2025

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