Pandémie de COVID-19 : le « dilemme du tramway » pour expliquer l’allocation des ressources rares

Sante Publique. 2022;33(6):803-811. doi: 10.3917/spub.216.0803.
[Article in French]


Introduction: The SARS-CoV-2 virus that appeared in December 2019 in the city of Wuhan in China spread rapidly. Severe forms of this virus infection cause acute respiratory distress syndromes (ARDS) requiring hospitalization of affected patients in intensive care units (IUCs), providing mechanical ventilation. The capacity of ICUs in the countries most affected by this health crisis quickly became overwhelmed, forcing healthcare providers to choose the patients who would benefit from care. Managing the overload of a healthcare system is the role of disaster medicine, for which one of the principles is the triage of patients according to their severity. Having to choose between patients means choosing a statement between deontology (judging the morality of an action according to its intention) and utilitarianism (judging the morality of an action by its consequences).

Aim: The aims of this article are, through the analysis of the trolley problem, to understand and justify the process of allocation of scarce resources found in the guidelines used in the context of the COVID-19 pandemic.

Results: The analysis of the trolley problem allows us to understand in what way our choices are utilitarian or deontological. Saving as many lives as possible", as advocated in the guidelines, is utilitarian.

Conclusions: These answers will provide a better understanding of all of the different ways of allocating scare resources according to the deontological or utilitarian approach, especially the one found in the disaster medicine guidelines.

MeSH terms

  • COVID-19* / epidemiology
  • Humans
  • Intensive Care Units
  • Pandemics
  • SARS-CoV-2
  • Triage