Does the public think age matters in COVID-19 triage?

By Margot N I Kuylen

On what basis should we allocate resources when resources are scarce? The COVID-19 pandemic has made this complex ethical question extremely salient, as newspapers reported at various points that critical care units across the world were reaching, or even exceeding, their capacity.

A wealth of triage guidance has been published since the onset of the pandemic. One recurring theme within these was the role of age, as several guidelines included age as an explicit factor for triage decisions.

There has been fruitful academic debate about the right – or least wrong – approach to pandemic triage, and the role of age has been hotly discussed. Less is known, however, about the views of the public on these issues. Since the public is immediately affected by triage policies, we wanted to explore public intuitions about triage decision-making, with particular focus on the role of age and related factors such as frailty and quality of life.

Rather than conducting an opinion poll, eliciting pre-existing preferences, we decided to conduct a study following the general method of deliberative democracy. We provided extensive background information to participants, and guided them through a total of eight hours of deliberation. This way, we wanted to ensure that participants formed an informed and considered opinion on this deeply complex ethical question. We found that participants, indeed, arrived at more nuanced views as deliberations progressed. Interestingly, the usual theory-driven approaches to resource allocation, such as the ‘fair innings’ principle, gained surprisingly little traction during this process.

Not only did our findings confirm the public is definitely capable of complex and critical ethical thought. During our study, new and original considerations emerged, most notably a preference for saving lives rather than life years and a concern for vulnerability. Therefore, we think that public consultations are not merely key for ensuring triage guidelines have democratic legitimacy: they may even help academics and policy makers rethink the debate.


Paper title: Does age matter in COVID-19 triage? A deliberative study

Authors: Kuylen, Margot NI (1), Kim, Scott Y.H.(2), Ruck Keene, Alexander (1,3), Owen, Gareth S.(1)

Affiliations: (1) Department of Psychological Medicine, King’s College London, UK (2) Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, USA, (3) 39 Essex Chambers, London, UK

Competing interests: Alexander Ruck Keene is a member of the Legal and Ethical Policy Unit of the Faculty of Intensive Care Medicine.

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