COVID-19: when health care resources run short, how to pick who should (not) get treated?

The World Health Organization had long warned of the onset of a pandemic that could throw national health systems into a major crisis, even in wealthy developed nations. Nonetheless, almost a year and a half after its appearance, Covid-19 continues to make painful triage choices necessary in granting access intensive care. Based on the opinions of numerous ethics committees and scientific societies, the article aims to illustrate the difference between the utilitarian-collectivist approach and the ethical approach, which inspired the guidelines drawn up in Italy in 2021 by SIAARTI in collaboration with SIMLA. Only medical parameters should be evaluated to establish the prognosis through which to identify the patients to be treated as a priority. Otherwise, the patient's interest is subordinated to that of the community. But moral judgment cannot concern only the choices of doctors. According to the principle of beneficence, hospital directors and national and local health policy managers must also take action, in particular to eliminate waste of economic resources so as to allocate more of them to health protection, especially in consideration of the predictability with which infection rates increase, and in light of the fact that immunization through vaccination is only temporary.