THE PRACTICE OF MEDICINE:

When a group of doctors, ethicists and religious leaders got together to write New York's 2015 ethical guidelines for allocating ventilators in a pandemic, they coalesced around a clear principle: Scarce resources should go to the person most likely to be saved. But they had to contemplate another, tougher, situation: What if a number of patients were equally likely to benefit?

In that case, they decided, a lottery might be the fairest option.

The specter of such extreme rationing - a large number of critically ill patients confronting a finite supply of life-saving machinery - was grim but theoretical when debated by the philosophically minded panel. Now, as New York and other states gird for the possibility of a shortage of ventilators, that ethics roadmap could come actually into practice.

Even scarier is the prospect confronting many other states which could also see coronavirus overwhelm their hospitals: No guidelines at all.

"We haven't had a national conversation about how we are going to prioritize," said Ezekiel Emanuel, a physician-ethicist now at the University of Pennsylvania who was a health adviser to President Barack Obama. "We are not prepared for triage."

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