MARGINAL AND INFRAMARGINAL USES. Rabbi Marc Gellman explains "triage."

The allocation of scarce resources to an overwhelming number of needy people is one of the most daunting ethical conflicts a healer or protector can face. Who is to be saved when not all can be saved? This is not just an ethical question, it is an ethical nightmare, and we are watching the nightmare on television every night.

The procedure that has evolved involves ... basic economics.

The reason for triage decisions is the fact of limited resources. Now there is much to say about why lifesaving resources are limited in this catastrophe, but only a fool or an abject ideologue cannot grasp the fact that when the strongest possible storm hit the most vulnerable possible city, death, devastation and chaos were sure to follow in its wake no matter what the preparations for the storm. Yes, more could have been done, and nothing I say or believe ought to be construed in any way as justifying any possible malfeasance of what public officials could have or should have done ahead of this killer storm.

But the act of preparing to do more includes opportunity costs.

It is not merely naive but profoundly foolish to have expected that 100,000 troops with water and food and patrol vehicles and helicopters and busses and trains and showers and shelters and electricity and bulldozers and levee-repair crews and mobile kitchens and tent cities and psychological services and identity checkers and employment services and construction crews and electrical linemen and mechanical and structural and civil engineers and architects and water-control experts and animal-removal experts could have all been set up somewhere out of the storm path but close enough to swoop in and pluck the soaking victims out of harm’s way despite the collapsed bridges and levees the minute the winds stopped blowing and minute the tide subsided without missing a heartbeat.

And so to the heart of the matter.

Triage is where morality meets reality. It is precisely at times of chaos that morally informed but tough-minded triage decisions must be made, otherwise morality is simply a dilettante’s luxury and a mere intellectual puzzle for the philosophy classroom, but irrelevant on the street.

Guiding that morality: allocative efficiency.

In general, triage requires the splitting of the affected population into three groups. The first group is the group that is suffering fatal injuries and will probably not live no matter what is done to help them. The second group is the group of people who are affected but who are not suffering any life-threatening injuries. The third group is the group of people whose lives are at risk, and who will die soon if they are not treated right away but who will live if they are treated. The moral thrust of triage is to identify the third group as soon as possible and give them the first claim on the scarce resources that are available.

The people who will recover are inframarginal patients, as are the people who will not recover. At the margin, resources allocated to anything more than making those patients comfortable are resources not available to help the people who will die without the help. Behind what Rabbi Gelman describes as the "moral thrust" is pure allocative efficiency, making the marginal patients better off while leaving the inframarginal patients no worse off.

And his conclusion restates the fundamental economic problem.

I believe we are compelled to acknowledge that no possible scenario of human existence will ever free us from more than occasionally having too much need and not enough help. Killer storms, wars, famines and other natural catastrophes will test us forever. That is the most sad fact of life here on planet earth. And in the face of temporarily scarce lifesaving resources, there will always be those whose idea of helping is to scream, accuse and point fingers at people they hated before the storm.

Read the whole column, and reflect on the accomplishments that enable the Rabbi to refer to "temporarily scarce" lifesaving resources.