Despite a decade of planning and development of crisis standards of care (CSC) in the U.S., real-time experiences during the COVID-19 pandemic and other disasters have highlighted shortcomings involving potentially disparate outcomes among patients across racial, ethnic, socioeconomic, and other groups. Diverse causes of health inequities underlie critical distinctions in medico-legal approaches to allocating scarce resources. What is medically-warranted to save patients’ lives must be balanced against anti-discrimination laws. In this Commentary we examine medical and legal challenges implicated in real-time allocations of limited resources to promote public health, offering a unified approach to diminish disparate impacts among patients.