Too old to save? COVID-19 and age-based allocation of lifesaving medical care.

Adults aged 65 and over are disproportionately impacted by the coronavirus disease 2019 (COVID-19) pandemic and represent by far the largest share of severe disease and death. This paper critically examines ethical arguments for using implicit and explicit age criteria as a standard for allocating scarce lifesaving resources during the pandemic. Section 1 introduces the topic. Section 2 distinguishes standard from pandemic triage. Section 3 assesses ethical arguments for criteria that are implicitly age-based, including quality-adjusted life years, disability adjusted-life years, and total number of future life years. Section 4 examines ethical arguments for criteria that are more directly age-based, including fair innings, equality between old and young, and priority to the worse off. The paper concludes that neither implicit nor explicit age-based allocation withstands careful scrutiny.