Ethical principles used for resource allocation
| Allocation principle | Description example | Pros | Cons |
|---|---|---|---|
| Treating people equally | |||
| Lottery | Military draft, vaccinations, employee drug screening | Hard to corrupt; little knowledge about recipients | Blind to other factors and ignores relevant principles |
| Waiting list on a first-come, first-served principle | ICU beds, organ allocation | Favors those with access: wealthy, powerful, and well-connected | Protects existing doctor-patient relationships; exposes inequities (lack of insurance, undesirable groups such as prisoners) |
| Favoring the worse off: Prioritarianism | |||
| Sickest first | Emergency room triage, organ allocation | Priority to those suffering right now; “rule of rescue”; makes sense in temporary scarcity; proxy for being worst off overall | Ignores needs of those who will become sick in future; might falsely assume temporary scarcity; leads to people receiving interventions only after prognosis deteriorates |
| Youngest first | ACIP pandemic flu vaccine proposal12 | Benefits those who have had least life; prudent planners have an interest in living to old age | Undesirable priority of infants over adolescents and young adults (eg, 2-month-old has less life than 20-year-old but is prioritized) |
| Maximizing benefits to all: Utilitarianism | |||
| Prognosis (highest survival probability and duration) | Disaster triage, penicillin distribution | Maximizes life years produced | Ignores distributive principles; does not consider number of lives saved |
| Number of lives saved | Bioterrorism response | Avoids need to compare quality of life; less time spent deliberating | Ignores other principles |
| Promoting and rewarding social usefulness | |||
| Behavior | Gives priority to those who did not engage in risky behaviors that caused their condition or affected it negatively | Promotes healthy lifestyle and individual responsibility | Ignores the reason for the individual behavior |
| Instrumental value | PPEs to essential healthcare workers during pandemics | Serves saving most lives because protects those who can help save others | Prone to abuse |
| Reciprocity | Rewards irreplaceable people who have served public | Justice to people who have contributed in the past | Rewards only those who have voluntarily provided societal services in the past; requires time to inquire |
ICU = intensive care unit; PPE = personal protective equipment