The Absurdity of 'Triage' and the Need for Social Change

In response to a recent blog post by Steve of L.O.V.E. on "Holistic veganism," Elaine Vigneault responded that she works within a "triage" framework. I understand the "triage" concept as Elaine and others use it in relation to nonhuman animals, but I also think it's a flawed and problematic metaphor.

Triage is where a degree of urgency is assigned to those with wounds or illnesses in order to most effectively treat the patients or casualties. By definition then, triage takes place after the harm has already happened, and is therefore incapable of dealing with the cause of that harm. As Steve says, it's about handling the consequences of exploitation without actually addressing the exploitation as the cause. So I think Steve hits on exactly why is "triage" is failing, and is doomed to always fail. Read more...

In response to a recent blog post by Steve of L.O.V.E. on "Holistic veganism," Elaine Vigneault responded that she works within a "triage" framework. I understand the "triage" concept as Elaine and others use it in relation to nonhuman animals, but I also think it's a flawed and problematic metaphor.

Triage is where a degree of urgency is assigned to those with wounds or illnesses in order to most effectively treat the patients or casualties. By definition then, triage takes place after the harm has already happened, and is therefore incapable of dealing with the cause of that harm. As Steve says, it's about handling the consequences of exploitation without actually addressing the exploitation as the cause. So I think Steve hits on exactly why is "triage" is failing, and is doomed to always fail.

Triage and the System

I think the old TV series M*A*S*H illustrates well the absurdity of triage. For those unfamiliar with the show, it is a situation comedy/drama that takes place in a Mobile Army Surgical Hospital (or MASH unit) during the U.S.-led warfare in Korea. Naturally, given the situation, triage is a consistent theme throughout the series as the doctors have to decide who needs immediate medical attention, who can wait, and who will be left to die because their injures are so great or time consuming that it would impede the doctors ability to treat others.

The absurdity of triage is that no matter how many soldiers the doctors saved, the wounded just kept coming in. This is because the doctors doing triage were working within the system. The doctors are, after all, U.S. Army doctors and serve an essential function in the war machine. In fact, several episodes make it clear that the doctors performing triage are actually part of the problem – as the soldiers they saved would be sent back into battle only to return with new injuries, or the doctors would get news of the death of soldiers they just treated. As a sad irony, it turns out that the doctors, by doing triage, actually share responsibility in the continuation of the very war that is the reason soldiers are wounded in the first place.

The point is, as long as the war continues there will always be more wounded soldiers and a greater need for triage. That's why triage is a failure – it can mend a soldier, but it can't prevent that soldier from being wounded. So the answer isn't triage, but rather the prevention of what leads to triage. Because if we are going to resign ourselves to doing triage, then we have already resigned ourselves to failure.

From "Triage" to Prevention

If we want to eliminate the exploitation of other animals, then we need to make the structure of their exploitation our focus. That is, we need to look at how we can prevent exploitation, just like we need to look at preventing war. Because, just as long as there is war there will be always be wounded soldiers, if we don't address the exploitation that is underlying the structure of human supremacy and is justified by speciesism, then there will always be nonhuman animals who are casualties of that exploitation.

So Steve is right to question the ethical validity of triage. In the "triage" framework, some forms of exploitation are seen as the "worst abuses" – such as battery cages or crates – some are written off completely – honey bees, for example – and others we are told can wait – like so-called "free-range" operations. But again, as with wounded soldiers, these are all things that shouldn't exist in the first place. Once we start to set up these sorts of "triage" hierarchies we are working within the very system that is the problem, rather than working to prevent that system.

Which is why we need to question the rationale for ranking violence and exploitation in the first place. This sort of "triage" permeates nonhuman animal advocacy campaigns that target the so-called "worst abuses." This is all too common, and I fear we often fail to realize how offensive this framework really is.

The important point isn't whether these animals or those animals suffer the most from their exploitation. Suffering shouldn't be framed as a competition. And lets admit it, "triage" is a zero-sum, competitive framework. The more central point is how, because some cases are seen as "worse" than others, the exploitation of some animals is considered somehow "humane" or less harmful. Thus the exploitation and eventual death of these assumed "humane" cases of exploitation are virtually ignored, proving that exploitation itself, the very thing creating the demand for "triage," is ultimately left unquestioned.

Prevention means radically transforming our perspective on the exploitation of other animals. Instead of taking the exploitation of other animals for granted and working to do "triage" on the so-called "worst" cases – while leaving others to linger in their exploitation – we view the exploitation of any animals as obsolete. No longer is exploitation a seen as a given, but as something that needs to be radically replaced with nonexploitation. Keep in mind that by making obsolete the exploitation of other animals we are also making triage obsolete as well.

Social change starts with believing another world is possible. "Triage" belongs to the world we wish to leave behind. We can work here and now to cultivate a world where violence and exploitation aren't put in a hierarchy of most and least acceptable because we refuse to take any violence or exploitation for granted. This is exactly the sort of social transformation toward a nonviolent, nonexploitative society that veganism is about.

Re: The Absurdity of 'Triage' and the Need for Social Change

"Prevention means radically transforming our perspective on the exploitation of other animals."

Powerful post, Ida!
Keep up the great work!

Re: The Absurdity of 'Triage' and the Need for Social Change

Thanks, Ida, for your thoughtful and critical analysis of this concept. I've struggled to find the right words to suit the intrinsic discomfort I feel for the idea of "ending suffering," and you've managed to do that in a clear, concise, and effective way. It breaks my heart that so many people seek to end suffering without ever exploring the reasons why the suffering exists in the first place. Triage will never end the war, and mostly just exhausts our resources and ourselves in the process.

Iraq & Afghanistan invasions also illustrate this

I thought about this issue recently when I read Better: A Surgeon's Notes on Performance by Atul Gawande.

He has a chapter on the new methods of triage being used in the wars in Iraq and Afghanistan, which have reduced deaths from the historical 25% of injured soldiers to 10%. These wars represent the largest number of casualties since the Vietnam War, but you would never know it since it's deaths that grab people's attention. But now we have all these people who have been ridiculously, permanently injured, but don't worry, they're not dead.

Some of the methods he discusses include simply getting soldiers to wear their Kevlar vests and making goggles cooler-looking so that soldiers will wear them. While getting soldiers to wear protection might be considered "prevention" of injuries, it highlights how true prevention must operate completely outside of the system.

The end of the chapter really sums up the fool's errand of focusing on trying to mend wounded soldiers rather than not putting them in harm's way in the first place: one of the Army surgeons was hit in a rocket-propelled-grenade attack and died.

Gawande has another chapter on doctors who participate in administering lethal injections for the death penalty. Some do so to prevent unnecessary suffering. But there he takes the stand that doctors should be banned from participating in executions, and if executions cannot be performed without doctors, then the death penalty should be abolished.

I think it's interesting that because military doctors are viewed as saving lives, he doesn't think doctors should be banned from the military, even though the whole point of the military is to kill and injure other people. Doctors are integral to the military; the military has its own medical school & pays for people to go to medical school. Since the military couldn't go on without them, doctors could save more lives by opting out of rather than by taking part in the military.

Re: The Absurdity of 'Triage' and the Need for Social Change

Pretty thought-provoking. I had some thoughts on this Ida, so I wrote a little response:

http://thatvegangirl.com/?p=1072

Re: The Absurdity of 'Triage' and the Need for Social Change

Agreed!!! Sorry, can't say much more than that...