Ethical principles used for resource allocation

Allocation principleDescription exampleProsCons
Treating people equally
LotteryMilitary draft, vaccinations, employee drug screeningHard to corrupt; little knowledge about recipientsBlind to other factors and ignores relevant principles
Waiting list on a first-come, first-served principleICU beds, organ allocationFavors those with access: wealthy, powerful, and well-connectedProtects existing doctor-patient relationships; exposes inequities (lack of insurance, undesirable groups such as prisoners)
Favoring the worse off: Prioritarianism
Sickest firstEmergency room triage, organ allocationPriority to those suffering right now; “rule of rescue”; makes sense in temporary scarcity; proxy for being worst off overallIgnores needs of those who will become sick in future; might falsely assume temporary scarcity; leads to people receiving interventions only after prognosis deteriorates
Youngest firstACIP pandemic flu vaccine proposal12Benefits those who have had least life; prudent planners have an interest in living to old ageUndesirable 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 distributionMaximizes life years producedIgnores distributive principles; does not consider number of lives saved
Number of lives savedBioterrorism responseAvoids need to compare quality of life; less time spent deliberatingIgnores other principles
Promoting and rewarding social usefulness
BehaviorGives priority to those who did not engage in risky behaviors that caused their condition or affected it negativelyPromotes healthy lifestyle and individual responsibilityIgnores the reason for the individual behavior
Instrumental valuePPEs to essential healthcare workers during pandemicsServes saving most lives because protects those who can help save othersProne to abuse
ReciprocityRewards irreplaceable people who have served publicJustice to people who have contributed in the pastRewards only those who have voluntarily provided societal services in the past; requires time to inquire
  • ICU = intensive care unit; PPE = personal protective equipment