Explain the ethical principles involved in resource allocation during a disaster or mass casualty event.

• A. Triage should always save the youngest patients.
• B. Triage should randomize.
• C. Triage should prioritize expensive treatments.
• D. Justice, equity, and beneficence guide triage decisions; prioritize saving the most lives or life-years, while treating people with dignity and transparency.

Answer: (D)

In disaster and mass casualty situations, decisions about scarce resources are guided by justice, equity, beneficence, and respect for persons, with an emphasis on transparency. The aim is to save as many lives as possible or, in some approaches, maximize life-years, while ensuring that people are treated with dignity and that the process is openly communicated and fair. This means allocating resources to those most likely to benefit, considering the probability of survival and potential for recovery, and applying criteria consistently rather than on nonclinical factors such as age, social worth, or ability to pay. It also requires that the criteria and process be communicated clearly to both staff and the public to maintain trust. Randomization may be used only when there is no meaningful difference between patients after all other criteria have been considered, and it is not the primary method guiding triage. Prioritizing expensive treatments or other non-benefit-based criteria would undermine the goal of maximizing overall benefit and fairness.