About this topic
Summary The allocation of medical resources is a subfield within more general concerns about distributive justice. As such, much discussion of healthcare allocation uses familiar terms and theories from this broader area. However, it is also a subject that has been seen by many to have particular importance, due to the central importance that health plays in human lives. Resource allocations are typically driven by two competing factors: 'efficiency' (on the grounds that we should want resources in a social institution like medicine to bring about more benefit rather than less) and 'equality' (on the grounds people can suffer to differing degrees from ill health, and we should have some preference to help those who are worse off). Broadly speaking, many discussions of health care allocation are discussions of how to understand, and how to make commensurable, these two competing considerations. More recently, there has also been a turn towards the idea that since there may be no single, uniquely acceptable way of allocating medical resources, a theory of fair medical allocation must include some discussion of procedural principles, i.e. principles that relate to the process by which actual allocation decisions are made. 
Key works Bognar & Hirose 2014 Daniels 2007
Introductions Cookson & Dolan 2000 Buchanan 1984
Related categories

492 found
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1 — 50 / 492
  1. (Draft) The Prospects for Prospect Utilitarianism.Benjamin Davies - manuscript
    Sufficientarianism is a view of distributive justice that places importance on one or more ‘thresholds’, whereby those who are above the threshold have much weaker claims to additional benefits than those below, and may even have no claims at all. Hun Chung has recently argued for a new theory of distributive justice that overcomes two central problems faced by sufficientarianism. Sufficientarianism cannot give intuitively compelling answers to ‘lifeboat cases’, where we can save the lives of some but not all of (...)
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  2. Responsibility and the Recursion Problem.Ben Davies - forthcoming - Ratio.
    A considerable literature has emerged around the idea of using ‘personal responsibility’ as an allocation criterion in healthcare distribution, where a person's being suitably responsible for their health needs may justify additional conditions on receiving healthcare, and perhaps even limiting access entirely, sometimes known as ‘responsibilisation’. This discussion focuses most prominently, but not exclusively, on ‘luck egalitarianism’, the view that deviations from equality are justified only by suitably free choices. A superficially separate issue in distributive justice concerns the two–way relationship (...)
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  3. We Should Not Use Randomization Procedures to Allocate Scarce Life-Saving Resources.Roberto Fumagalli - forthcoming - Public Health Ethics.
    In the recent literature across philosophy, medicine and public health policy, many influential arguments have been put forward to support the use of randomization procedures to allocate scarce life-saving resources. In this paper, I provide a systematic categorization and a critical evaluation of these arguments. I shall argue that those arguments justify using randomization procedures to allocate scarce life-saving resources in fewer cases than their proponents maintain and that the relevant decision makers should typically allocate scarce life-saving resources directly to (...)
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  4. Special Supplement: What Do We Owe the Elderly? Allocating Social and Health Care Resources.Ruud ter Meulen, Eva Topinková & Daniel Callahan - forthcoming - Hastings Center Report.
  5. Value Assessment Frameworks: Who is Valuing the Care in Healthcare?Jonathan Anthony Michaels - forthcoming - Journal of Medical Ethics:medethics-2020-106503.
    Many healthcare agencies are producing evidence-based guidance and policy that may determine the availability of particular healthcare products and procedures, effectively rationing aspects of healthcare. They claim legitimacy for their decisions through reference to evidence-based scientific method and the implementation of just decision-making procedures, often citing the criteria of ‘accountability for reasonableness’; publicity, relevance, challenge and revision, and regulation. Central to most decision methods are estimates of gains in quality-adjusted life-years, a measure that combines the length and quality of survival. (...)
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  6. Why We Should Stop Using Animal-Derived Products on Patients Without Their Consent.Daniel Rodger - forthcoming - Journal of Medical Ethics.
    Medicines and medical devices containing animal-derived ingredients are frequently used on patients without their informed consent, despite a significant proportion of patients wanting to know if an animal-derived product is going to be used in their care. Here, I outline three arguments for why this practice is wrong. Firstly, I argue that using animal-derived medical products on patients without their informed consent undermines respect for their autonomy. Secondly, it risks causing non-trivial psychological harm. Thirdly, it is morally inconsistent to respect (...)
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  7. How the Past Matters for the Future: A Luck Egalitarian Sustainability Principle for Healthcare Resource Allocation.Andreas Albertsen - 2021 - Journal of Medical Ethics 47 (2):102-103.
    Christian Munthe, David Fumagalli and Erik Malmqvist argue that well-known healthcare resource allocation principles, such as need, prognosis, equal treatment and cost-effectiveness, should be supplemented with a principle of sustainability.1 Employing such a principle would entail that the allocation of healthcare resources should take into account whether a specific allocation causes negative dynamics, which would limit the amount of resources available in the future. As examples of allocation decisions, which may have such negative dynamics, they mention those who cause a (...)
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  8. What’s the Appropriate Target of Allocative Justification?Zara Anwarzai & Ricky Mouser - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):167-168.
    Building on work by Peterman, Aas, and Wasserman (2021), we modify their prospective benefit analysis to include only medically-relevant information about patients as persons without reference to their broader lives. Because patients (not their lives) must be treated equally, we argue that patients are the appropriate targets of allocative justification. We go on to challenge some of our current data-collection practices on this basis.
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  9. Precautionary Personhood: We Should Treat Patients with Disorders of Consciousness as Persons.Matthew Braddock - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):162-164.
    Should we allocate costly health care to patients diagnosed with disorders of consciousness (DoC), such as patients diagnosed as being in a vegetative state or minimally conscious state? Peterson, Aas, and Wasserman (2021) argue that we should in their paper “What justifies the allocation of health care resources to patient with disorders of consciousness?” Their key insight is that the expected benefits to this patient population helps to justify such allocations. However, their insight is attached to a consequentialist framework aimed (...)
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  10. Mistrust and Inconsistency During COVID-19: Considerations for Resource Allocation Guidelines That Prioritise Healthcare Workers.Alexander T. M. Cheung & Brendan Parent - 2021 - Journal of Medical Ethics 47 (2):73-77.
    As the USA contends with another surge in COVID-19 cases, hospitals may soon need to answer the unresolved question of who lives and dies when ventilator demand exceeds supply. Although most triage policies in the USA have seemingly converged on the use of clinical need and benefit as primary criteria for prioritisation, significant differences exist between institutions in how to assign priority to patients with identical medical prognoses: the so-called ‘tie-breaker’ situations. In particular, one’s status as a frontline healthcare worker (...)
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  11. Grow the Pie, or the Resource Shuffle? Commentary on Munthe, Fumagalli and Malmqvist.Ben Davies - 2021 - Journal of Medical Ethics 47 (2):98-99.
    John Rawls’s ‘just savings’ principle is among the better-known attempts to outline how we should balance the claims of the present with the claims of the future generations on resources. A central element of Rawls’s approach involves endorsing a sufficientarian approach, where our central obligation is to ensure ‘the conditions needed to establish and to preserve a just basic structure’.1 This engaging paper by Christian Munthe, Davide Fumagalli and Erik Malmqvist does not explicitly mention Rawls’s work on this issue.2 Still, (...)
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  12. ‘Personal Health Surveillance’: The Use of mHealth in Healthcare Responsibilisation.Ben Davies - 2021 - Public Health Ethics 14 (3):268-280.
    There is an ongoing increase in the use of mobile health technologies that patients can use to monitor health-related outcomes and behaviours. While the dominant narrative around mHealth focuses on patient empowerment, there is potential for mHealth to fit into a growing push for patients to take personal responsibility for their health. I call the first of these uses ‘medical monitoring’, and the second ‘personal health surveillance’. After outlining two problems which the use of mHealth might seem to enable us (...)
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  13. Healthcare, Responsibility and Golden Opportunities.Gabriel De Marco, Thomas Douglas & Julian Savulescu - 2021 - Ethical Theory and Moral Practice 1 (3).
    When it comes to determining how healthcare resources should be allocated, there are many factors that could—and perhaps should—be taken into account. One such factor is a patient’s responsibility for his or her illness, or for the behavior that caused it. Policies that take responsibility for the unhealthy lifestyle or its outcomes into account—responsibility-sensitive policies—have faced a series of criticisms. One holds that agents often fail to meet either the control or epistemic conditions on responsibility with regard to their unhealthy (...)
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  14. Understanding Government Decisions to De-Fund Medical Services Analyzing the Impact of Problem Frames on Resource Allocation Policies.Mark Embrett & Glen E. Randall - 2021 - Health Care Analysis 29 (1):78-98.
    Many medical services lack robust evidence of effectiveness and may therefore be considered “unnecessary” care. Proactively withdrawing resources from, or de-funding, such services and redirecting the savings to services that have proven effectiveness would enhance overall health system performance. Despite this, governments have been reluctant to discontinue funding of services once funding is in place. The focus of this study is to understand how the framing of an issue or problem influences government decision-making related to de-funding of medical services. To (...)
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  15. Love Thy Neighbour? Allocating Vaccines in a World of Competing Obligations.Kyle Ferguson & Arthur Caplan - 2021 - Journal of Medical Ethics 47 (12):20-20.
    Although a safe, effective, and licensed coronavirus vaccine does not yet exist, there is already controversy over how it ought to be allocated. Justice is clearly at stake, but it is unclear what justice requires in the international distribution of a scarce vaccine during a pandemic. Many are condemning ‘vaccine nationalism’ as an obstacle to equitable global distribution. We argue that limited national partiality in allocating vaccines will be a component of justice rather than an obstacle to it. For there (...)
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  16. Phantom Premise and a Shape-Shifting Ism: Reply to Hassoun.Kyle Ferguson & Arthur Caplan - 2021 - Journal of Medical Ethics 47 (11).
    In ‘Against vaccine nationalism’, Nicole Hassoun misrepresents our argument, distorts our position and ignores crucial distinctions we present in our article, ‘Love thy neighbor? Allocating vaccines in a world of competing obligations’. She has created a strawman that does not resemble our position. In this reply, we address two features of ‘Against vaccine nationalism’. First, we address a phantom premise. Hassoun misattributes to us a thesis, according to which citizen-directed duties are stronger than noncitizen-directed duties. This thesis is a figment (...)
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  17. Ordeals, Women and Gender Justice.Anca Gheaus - 2021 - Economics and Philosophy 37 (1):8-22.
    Rationing health care by ordeals is likely to have different effects on women and men, and on distinct groups of women. I show how such putative effects of ordeals are relevant to achieving gender justice. I explain why some ordeals may disproportionately set back women’s interest in discretionary time, health and access to health care, and may undermine equality of opportunity for positions of advantage. Some ordeals protect the interests of the worse-off women yet set back the interests of better-off (...)
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  18. Rawlsian Contractualism and Healthcare Allocation: A Response to Torbjörn Tännsjö.Quinn Hiroshi Gibson - 2021 - Diametros 18 (68):9-23.
    The consideration of the problem of healthcare allocation as a special case of distributive justice is especially alluring when we only consider consequentialist theories. I articulate here an alternative Rawlsian non-consequentialist theory which prioritizes the fairness of healthcare allocation procedures rather than directly setting distributive parameters. The theory in question stems from Rawlsian commitments that, it is argued, have a better Rawlsian pedigree than those considered as such by Tännsjö. The alternative framework is worthy of consideration on its own merits, (...)
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  19. Sustainability Principle for the Ethics of Healthcare Resource Allocation.Christian Munthe, Davide Fumagalli & Erik Malmqvist - 2021 - Journal of Medical Ethics 47 (2):90-97.
    We propose a principle of sustainability to complement established principles used for justifying healthcare resource allocation. We argue that the application of established principles of equal treatment, need, prognosis and cost-effectiveness gives rise to what we call negative dynamics: a gradual depletion of the value possible to generate through healthcare. These principles should therefore be complemented by a sustainability principle, making the prospect of negative dynamics a further factor to consider, and possibly outweigh considerations highlighted by the other principles. We (...)
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  20. Difficult Trade-Offs in Response to COVID-19: The Case for Open and Inclusive Decision-Making.Ole Frithjof Norheim, Joelle Abi-Rached, Liam Kofi Bright, Kristine Baeroe, Octavio Ferraz, Siri Gloppen & Alex Voorhoeve - 2021 - Nature Medicine 27:10-13.
    We argue that deliberative decision-making that is inclusive, transparent and accountable can contribute to more trustworthy and legitimate decisions on difficult ethical questions and political trade-offs during the pandemic and beyond.
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  21. Prioritizing the Prevention of Early Deaths During Covid‐19.Govind Persad - 2021 - Hastings Center Report 51 (2):42-43.
    In this Correspondence, I argue that given that scarcity has existed both for critical care resources and for vaccines, allocating critical care resources to prioritize the prevention of early COVID-19 deaths (i.e. COVID-19 deaths among younger patients) could valuably counterbalance the disproportionate exclusion of minority patients and those with life shortening disabilities that age-based vaccine allocation produces. -/- Covid-19 deaths early in life have overwhelmingly befallen minorities and people with life-shortening disabilities. Policies preventing early deaths prevent an outcome widely recognized (...)
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  22. Public Perspectives on COVID-19 Vaccine Prioritization.Govind Persad, Ezekiel J. Emanuel, Samantha Sangenito, Aaron Glickman, Steven Phillips & Emily A. Largent - 2021 - JAMA Network Open 4:e217943.
    In this survey study of 4735 US adults, respondents of all demographic and political affiliations agreed with prioritizing COVID-19 vaccine access for health care workers, adults of any age with serious comorbid conditions, frontline workers (eg, teachers and grocery workers), and Black, Hispanic, Native American, and other communities that have been disproportionately affected by COVID-19. Older adult respondents were less likely than younger respondents to list healthy people older than 65 years as 1 of their top 4 priority groups. These (...)
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  23. Allocation of Scarce Biospecimens for Use in Research.Leah Pierson, Sophia Gibert, Benjamin Berkman, Marion Danis & Joseph Millum - 2021 - Journal of Medical Ethics 47 (11):740-743.
    Hundreds of millions of rare biospecimens are stored in laboratories and biobanks around the world. Often, the researchers who possess these specimens do not plan to use them, while other researchers limit the scope of their work because they cannot acquire biospecimens that meet their needs. This situation raises an important and underexplored question: how should scientists allocate biospecimens that they do not intend to use? We argue that allocators should aim to maximise the social value of the research enterprise (...)
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  24. The Complex Relationship Between Disability Discrimination and Frailty Scoring.Joel Michael Reynolds, Charles E. Binkley & Andrew Shuman - 2021 - American Journal of Bioethics 21 (11):74-76.
    In "Frailty Triage: Is Rationing Intensive Medical Treatment on the Grounds of Frailty Ethical?," Wilkinson (2021) argues that the use of frailty scores in ICU triage does not necessarily involve discrimination on the basis of disability. In support of this argument, he claims, “it is not the disability per se that the score is measuring – rather it is the underlying physiological and physical vulnerability." While we appreciate the attention Wilkinson explicitly pays to disability in this piece, we find the (...)
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  25. How Can We Decide a Fair Allocation of Healthcare Resources During a Pandemic?Cristina Roadevin & Harry Hill - 2021 - Journal of Medical Ethics 47 (12):84-84.
    Whenever the government makes medical resource allocation choices, there will be opportunity costs associated with those choices: some patients will have treatment and live longer, while a different group of patients will die prematurely. Because of this, we have to make sure that the benefits we get from investing in treatment A are large enough to justify the benefits forgone from not investing in the next best alternative, treatment B. There has been an increase in spending and reallocation of resources (...)
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  26. Triage and Justice in an Unjust Pandemic: Ethical Allocation of Scarce Medical Resources in the Setting of Racial and Socioeconomic Disparities.Benjamin Tolchin, Sarah C. Hull & Katherine Kraschel - 2021 - Journal of Medical Ethics 47 (3):200-202.
    Shortages of life-saving medical resources caused by COVID-19 have prompted hospitals, healthcare systems, and governmentsto develop crisis standards of care, including 'triage protocols' to potentially ration medical supplies during the public health emergency. At the same time, the pandemic has highlighted and exacerbated racial, ethnic, and socioeconomic health disparities that together constitute a form of structural racism. These disparities pose a critical ethical challenge in developing fair triage systems that will maximize lives saved without perpetuating systemic inequities. Here we review (...)
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  27. Rural Bioethics: The Alaska Context.Fritz Allhoff & Luke Golemon - 2020 - HEC Forum 32 (4):313-331.
    With by far the lowest population density in the United States, myriad challenges attach to healthcare delivery in Alaska. In the “Size, Population, and Accessibility” section, we characterize this geographic context, including how it is exacerbated by lack of infrastructure. In the “Distributing Healthcare” section, we turn to healthcare economics and staffing, showing how these bear on delivery—and are exacerbated by geography. In the “Health Care in Rural Alaska” section, we turn to rural care, exploring in more depth what healthcare (...)
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  28. Pandemic Ethics: 8 Big Questions of COVID-19.Ben Bramble - 2020 - Sydney: Bartleby Books.
    A clear and provocative introduction to the ethics of COVID-19, suitable for university-level students, academics, and policymakers, as well as the general reader. It is also an original contribution to the emerging literature on this important topic. The author has made it available Open Access, so that it can be downloaded and read for free by all those who are interested in these issues. Key features include: -/- A neat organisation of the ethical issues raised by the pandemic. An exploration (...)
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  29. Ethical Allocation of Remdesivir.Parker Crutchfield, Tyler S. Gibb, Michael J. Redinger & William Fales - 2020 - American Journal of Bioethics 20 (7):84-86.
    As the federal government distributed remdesivir to some of the states COVID-19 hit hardest, policymakers scrambled to develop criteria to allocate the drug to their hospitals. Our state, Michigan, was among those states to receive an initial quantity of the drug from the U.S. government. The disparities in burden of disease in Michigan are striking. Detroit has a death rate more than three times the state average. Our recommendation to the state was that it should prioritize the communities that bear (...)
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  30. Disability, Epistemic Harms, and the Quality-Adjusted Life Year.Laura M. Cupples - 2020 - International Journal of Feminist Approaches to Bioethics 13 (1):46-62.
    Health policymakers employ utility measures to inform resource allocation decisions. They often rely on a conceptual tool called the quality-adjusted life year that discounts the value of years lived in a state of disability relative to years lived in full health. A representative sample of the general public is asked to place values on hypothetical health states as part of a standard gamble or time trade-off task. Policymakers use the resulting values to calculate the number of QALYs gained through particular (...)
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  31. From Sufficient Health to Sufficient Responsibility.Ben Davies & Julian Savulescu - 2020 - Journal of Bioethical Inquiry 17 (3):423-433.
    The idea of using responsibility in the allocation of healthcare resources has been criticized for, among other things, too readily abandoning people who are responsible for being very badly off. One response to this problem is that while responsibility can play a role in resource allocation, it cannot do so if it will leave those who are responsible below a “sufficiency” threshold. This paper considers first whether a view can be both distinctively sufficientarian and allow responsibility to play a role (...)
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  32. Ethics as Usual? Unilateral Withdrawal of Treatment in a State of Exception.Jason T. Eberl - 2020 - American Journal of Bioethics 20 (7):210-211.
    Do extraordinary crisis situations requiring life-and-death decisions create a “state of exception” in which ordinary social, political, and ethical norms must be altered or suspended altogether? Daniel Sulmasy contends that the extraordinary circumstances of a pandemic do not require abandoning or altering ethical values and principles. Rather, “ethics as usual” ought to guide policy formation and clinical decision-making. One critical question raised by the current pandemic, and which stresses ordinary ethical standards, is whether ventilators or other scarce life-sustaining resources may (...)
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  33. Black Lives in a Pandemic: Implications of Systemic Injustice for End‐of‐Life Care.Alan Elbaum - 2020 - Hastings Center Report 50 (3):58-60.
    In recent months, Covid‐19 has devastated African American communities across the nation, and a Minneapolis police officer murdered George Floyd. The agents of death may be novel, but the phenomena of long‐standing epidemics of premature black death and of police violence are not. This essay argues that racial health and health care disparities, rooted as they are in systemic injustice, ought to carry far more weight in clinical ethics than they generally do. In particular, this essay examines palliative and end‐of‐life (...)
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  34. An Ethical Framework for Global Vaccine Allocation.Ezekiel J. Emanuel, Govind Persad, Adam Kern, Allen E. Buchanan, Cecile Fabre, Daniel Halliday, Joseph Heath, Lisa M. Herzog, R. J. Leland, Ephrem T. Lemango, Florencia Luna, Matthew McCoy, Ole F. Norheim, Trygve Ottersen, G. Owen Schaefer, Kok-Chor Tan, Christopher Heath Wellman, Jonathan Wolff & Henry S. Richardson - 2020 - Science 1:DOI: 10.1126/science.abe2803.
    In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...)
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  35. Fair Allocation of Scarce Medical Resources in the Time of Covid-19.Ezekiel J. Emanuel, Govind Persad, Ross Upshur, Beatriz Thome, Michael Parker, Aaron Glickman, Cathy Zhang, Connor Boyle & James P. Phillips - 2020 - New England Journal of Medicine:10.1056/NEJMsb2005114.
    Four ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the Covid-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all Covid-19 and non–Covid-19 patients.
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  36. Disability Rights as a Necessary Framework for Crisis Standards of Care and the Future of Health Care.Laura Guidry-Grimes, Katie Savin, Joseph A. Stramondo, Joel Michael Reynolds, Marina Tsaplina, Teresa Blankmeyer Burke, Angela Ballantyne, Eva Feder Kittay, Devan Stahl, Jackie Leach Scully, Rosemarie Garland-Thomson, Anita Tarzian, Doron Dorfman & Joseph J. Fins - 2020 - Hastings Center Report 50 (3):28-32.
    In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails a commitment to both (...)
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  37. Egalitarian Provision of Necessary Medical Treatment.Robert C. Hughes - 2020 - The Journal of Ethics 24 (1):55-78.
    Considerations of autonomy and independence, properly understood, support strictly egalitarian provision of necessary medical treatment. If the financially better-off can purchase access to necessary medical treatments that the financially less well-off cannot purchase without help, then their discretionary power to give or to withhold monetary gifts indirectly gives them the power to make life-and-death or sickness-and-health decisions for others. To prevent private citizens from having this objectionable form of power, government must ensure that citizens’ finances do not affect their access (...)
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  38. First Come, First Served?Tyler M. John & Joseph Millum - 2020 - Ethics 130 (2):179-207.
    Waiting time is widely used in health and social policy to make resource allocation decisions, yet no general account of the moral significance of waiting time exists. We provide such an account. We argue that waiting time is not intrinsically morally significant, and that the first person in a queue for a resource does not ipso facto have a right to receive that resource first. However, waiting time can and sometimes should play a role in justifying allocation decisions. First, there (...)
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  39. Dignity, Autonomy, and Allocation of Scarce Medical Resources During COVID-19.David G. Kirchhoffer - 2020 - Journal of Bioethical Inquiry 17 (4):691-696.
    Ruth Macklin argued that dignity is nothing more than respect for persons or their autonomy. During the COVID-19 pandemic, difficult decisions are being made about the allocation of scarce resources. Respect for autonomy cannot justify rationing decisions. Justice can be invoked to justify rationing. However, this leaves an uncomfortable tension between the principles. Dignity is not a useless concept because it is able to account for why we respect autonomy and for why it can be legitimate to override autonomy in (...)
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  40. Pox Parties for Grannies? Chickenpox, Exogenous Boosting, and Harmful Injustices.Heidi Malm & Mark Christopher Navin - 2020 - American Journal of Bioethics 20 (9):45-57.
    Some societies tolerate or encourage high levels of chickenpox infection among children to reduce rates of shingles among older adults. This tradeoff is unethical. The varicella zoster virus (VZV) causes both chickenpox and shingles. After people recover from chickenpox, VZV remains in their nerve cells. If their immune systems become unable to suppress the virus, they develop shingles. According to the Exogenous Boosting Hypothesis (EBH), a person’s ability to keep VZV suppressed can be ‘boosted’ through exposure to active chickenpox infections. (...)
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  41. Respecting Disability Rights — Toward Improved Crisis Standards of Care.Michelle M. Mello, Govind Persad & Douglas B. White - 2020 - New England Journal of Medicine:DOI: 10.1056/NEJMp2011997.
    We propose six guideposts that states and hospitals should follow to respect disability rights when designing policies for the allocation of scarce, lifesaving medical treatments. Four relate to criteria for decisions. First, do not use categorical exclusions, especially ones based on disability or diagnosis. Second, do not use perceived quality of life. Third, use hospital survival and near-term prognosis (e.g., death expected within a few years despite treatment) but not long-term life expectancy. Fourth, when patients who use ventilators in their (...)
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  42. Ethical Dimensions of the Global Burden of Disease.Christopher J. L. Murray & S. Andrew Schroeder - 2020 - In Nir Eyal, Samia Hurst, Christopher J. L. Murray, S. Andrew Schroeder & Daniel Wikler (eds.), Measuring the Global Burden of Disease: Philosophical Dimensions. New York, NY, USA: pp. 24-47.
    This chapter suggests that descriptive epidemiological studies like the Global Burden of Disease Study can usefully be divided into four tasks: describing individuals’ health states over time, assessing their health states under a range of counterfactual scenarios, summarizing the information collected, and then packaging it for presentation. The authors show that each of these tasks raises important and challenging ethical questions. They comment on some of the philosophical issues involved in measuring health states, attributing causes to health outcomes, choosing the (...)
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  43. Disability Law and the Case for Evidence-Based Triage in a Pandemic.Govind Persad - 2020 - Yale Law Journal Forum 130:26-50.
    This Essay explains why model policies proposed or adopted in response to the COVID-19 pandemic that allocate scarce medical resources by using medical evidence to pursue two core goals—saving more lives and saving more years of life—are compatible and consonant with disability law. Disability law, properly understood, permits considering medical evidence about patients’ probability of surviving treatment and the quantity of scarce treatments they will likely use. It also permits prioritizing health workers, and considering patients’ post-treatment life expectancy. These factors, (...)
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  44. A Conceptual Framework for Clearer Ethical Discussions About COVID-19 Response.Govind C. Persad - 2020 - American Journal of Bioethics 20 (7):98-101.
    In this Commentary, I propose an ethical framework for ethical discussions around the allocation of scarce resources in COVID-19 response. The framework incorporates four principles: beneficence (benefiting people by saving lives or years of life), equality, remedying disadvantage, and recognizing past conduct. I then discuss how the framework interacts with ethical constraints against using people as a mere means and against causing death. The commentary closes by criticizing the equation of deontological ethics with random or first-come, first-served allocation and of (...)
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  45. The Case for Valuing Non-Health and Indirect Benefits.Govind Persad & Jessica du Toit - 2020 - In Ole F. Norheim, Ezekiel J. Emanuel & Joseph Millum (eds.), Global Health Priority-Setting: Beyond Cost-Effectiveness. New York, NY, USA: pp. 207-222.
    Health policy is only one part of social policy. Although spending administered by the health sector constitutes a sizeable fraction of total state spending in most countries, other sectors such as education and transportation also represent major portions of national budgets. Additionally, though health is one important aspect of economic and social activity, people pursue many other goals in their social and economic lives. Similarly, direct benefits—those that are immediate results of health policy choices—are only a small portion of the (...)
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  46. Fairly Prioritizing Groups for Access to COVID-19 Vaccines.Govind Persad, Monica E. Peek & Ezekiel J. Emanuel - 2020 - JAMA 1.
    Initial vaccine allocations for the coronavirus disease 2019 (COVID-19) will be limited. It is crucial to assess the ethical values associated with different methods of allocation, as well as important scientific and practical questions. This Viewpoint identifies three ethical values, benefiting people and limiting harm; prioritizing disadvantaged populations; and equal concern for all. It then explains why these values support prioritizing three groups: health care workers; other essential workers and people in high-transmission settings; and people with medical vulnerabilities associated with (...)
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  47. Age Change in Healthcare Settings: A Reply to Lippert-Rasmussen and Petersen.Joona Räsänen - 2020 - Journal of Medical Ethics 46 (9):636-637.
    Lippert-Rasmussen and Petersen discuss my ‘Moral case for legal age change’ in their article ‘Age change, official age and fairness in health’. They argue that in important healthcare settings (such as distributing vital organs for dying patients), the state should treat people on the basis of their chronological age because chronological age is a better proxy for what matters from the point of view of justice than adjusted official age. While adjusted legal age should not be used in deciding who (...)
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  48. The Infectious Diseases Act and Resource Allocation During the COVID-19 Pandemic in Bangladesh.Md Sanwar Siraj, Rebecca Susan Dewey & A. S. M. Firoz Ul Hassan - 2020 - Asian Bioethics Review 12 (4):491-502.
    The Infectious Diseases Act entered into force officially on 14 November 2018 in Bangladesh. The Act is designed to raise awareness of, prevent, control, and eradicate infectious or communicable diseases to address public health emergencies and reduce health risks. A novel coronavirus disease was first identified in Bangladesh on 8 March 2020, and the Ministry of Health and Family Welfare issued a gazette on 23 March, listing COVID-19 as an infectious disease and addressing COVID-19 as a public health emergency. The (...)
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  49. Healthy Nails Versus Long Lives: An Analysis of a Dutch Priority Setting Proposal.Alex Voorhoeve - 2020 - In Nir Eyal, Samia A. Hurst, Christopher Murray, S. Andrew Schroeder & Daniel Wikler (eds.), Measuring the Global Burden of Disease: Philosophical Dimensions. New York, NY, USA: pp. 273-292.
    How should governments balance saving people from very large individual disease burdens (such as an early death) against saving them from middling burdens (such as erectile dysfunction) and minor burdens (such as nail fungus)? This chapter considers this question through an analysis of a priority-setting proposal in the Netherlands, on which avoiding a multitude of middling burdens takes priority over saving one person from early death, but no number of very small burdens can take priority over avoiding one death. It (...)
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  50. Setting Priorities Fairly in Response to Covid-19: Identifying Overlapping Consensus and Reasonable Disagreement.David Wasserman, Govind Persad & Joseph Millum - 2020 - Journal of Law and the Biosciences 1:doi:10.1093/jlb/lsaa044.
    Proposals for allocating scarce lifesaving resources in the face of the Covid-19 pandemic have aligned in some ways and conflicted in others. This paper attempts a kind of priority setting in addressing these conflicts. In the first part, we identify points on which we do not believe that reasonable people should differ—even if they do. These are (i) the inadequacy of traditional clinical ethics to address priority-setting in a pandemic; (ii) the relevance of saving lives; (iii) the flaws of first-come, (...)
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