About this topic
Summary The allocation of medical resources is a subfield within more general concerns about distributive justice. As such, much discussion of medical resource 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 role that health plays in human lives. Medical resource allocations are typically driven by two 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. Broader issues include the role of markets and insurance in access to medical care; whether states can set a package of 'basic healthcare' to which all are entitled; whether the allocation of medical resources should be sensitive to the responsibility of patients; and the potential for discrimination in various allocation principles. 
Key works Bognar & Hirose 2014 Daniels 2007 Fourie & Rid 2017 Scully 2020 Buchanan 1984
Introductions Cookson & Dolan 2000 Buchanan 1984 Norheim et al 2019 Segall 2009 Hassoun 2015
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  1. Association of Race and Ethnicity With High Longevity Deceased Donor Kidney Transplantation Under the US Kidney Allocation System.Nour Asfour, Kevin C. Zhang, Jessica Lu, Peter P. Reese, Milda Saunders, Monica Peek, Molly White, Govind Persad & William F. Parker - forthcoming - American Journal of Kidney Diseases.
  2. Fair Allocation of GLP-1 and Dual GLP-1-GIP Receptor Agonists.Ezekiel J. Emanuel, Johan L. Dellgren, Matthew S. McCoy & Govind Persad - forthcoming - New England Journal of Medicine.
    Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, and dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, such as tirzepatide, have been found to be effective for treating obesity and diabetes, significantly reducing weight and the risk or predicted risk of adverse cardiovascular events. There is a global shortage of these medications that could last several years and raises questions about how limited supplies should be allocated. We propose a fair-allocation framework that enables evaluation of the ethics of current (...)
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  3. 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.
  4. Bioethics: 50 Puzzles, Problems, and Thought Experiments.Sean D. Aas, Collin O'Neil & Chiara Lepora - 2024 - New York: Routledge.
    Bioethics: 50 Puzzles, Problems, and Thought Experiments collects 50 cases—both real and imaginary—that have been, or should be, of special interest and importance to philosophical bioethics. Cases are collected together under topical headings in a natural order for an introductory course in bioethics. Each case is described in a few pages, which includes bioethical context, a concise narrative of the case itself, and a discussion of its importance, both for broader philosophical issues and for practical problems in clinical ethics and (...)
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  5. Responsibility and Healthcare.Ben Davies, Gabriel De Marco, Neil Levy & Julian Savulescu (eds.) - 2024 - Oxford University Press USA.
    A volume with 14 chapters on various aspects of the relationship between responsibility and healthcare, plus a substantial introduction that offers a comprehensive overview of the relevant debates and how they relate to one another. -/- Questions of responsibility arise at all levels of health care. Most prominent has been the issue of patient responsibility. Some health conditions that risk death or serious harm are partly the result of lifestyle behaviours such as smoking, lack of exercise, or extreme sports. Are (...)
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  6. Manufactured scarcity and the allocation of scarce resources–Authors' reply.Ezekiel J. Emanuel & Govind Persad - 2024 - The Lancet 403 (10426):532.
  7. Making Sense of Race-Based Affirmative Action in Allocating Scarce Medical Resources.Yuichiro Mori - 2024 - Res Philosophica 101.
    The aim of this article is to consider whether, when, and why it is morally right to treat members of socially disadvantaged racial or ethnic groups favorably when allocating scarce medical resources. Since the COVID 2019 pandemic has had different impacts on racial and ethnic groups, some U.S. states have given racial and ethnic minorities preferential access to COVID-19 vaccines, leading to controversy over the moral and legal permissibility of doing so. I examine three arguments for affirmative action—the compensation, equality-of-opportunity, (...)
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  8. Obesity and Responsibility for Health.Rekha Nath - 2024 - In Ben Davies, Gabriel De Marco, Neil Levy & Julian Savulescu (eds.), Responsibility and Healthcare. Oxford University Press USA. pp. 184-209.
    This chapter examines the case for health care policies aimed at holding obese individuals responsible for their weight and for obesity-related health issues. In particular, it considers the merits of two arguments for policies that would seek to make obese individuals bear some of the higher health care costs associated with being that way. On the fairness argument, it is claimed that such policies would serve the interests of fairness by holding obese individuals to account for irresponsible lifestyle choices that (...)
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  9. Healthcare Priorities: The “Young” and the “Old”.Ben Davies - 2023 - Cambridge Quarterly of Healthcare Ethics 32 (2):174-185.
    Some philosophers and segments of the public think age is relevant to healthcare priority-setting. One argument for this is based in equity: “Old” patients have had either more of a relevant good than “young” patients or enough of that good and so have weaker claims to treatment. This article first notes that some discussions of age-based priority that focus in this way on old and young patients exhibit an ambiguity between two claims: that patients classified as old should have a (...)
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  10. Medical need and health need.Ben Davies - 2023 - Clinical Ethics 18 (3):287-291.
    I introduce a distinction between health need and medical need, and raise several questions about their interaction. Health needs are needs that relate directly to our health condition. Medical needs are needs which bear some relation to medical institutions or processes. I suggest that the question of whether medical insurance or public care should cover medical needs, health needs, or only needs which fit both categories is a political question that cannot be resolved definitionally. I also argue against an overly (...)
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  11. Allocation of Scarce Life-Saving Medical Resources: Why Does Age Matter?Felipe Dossena & Milene Tonetto - 2023 - Ethic@ - An International Journal for Moral Philosophy 22 (3):1111-1128.
    In this paper, we address the moral justification problem concerning the use of age as a criterion for the allocation of scarce life-saving medical resources. We present and discuss four justifications that stand out in philosophical literature: efficiency, sufficiency, egalitarian, and prioritarian. We aim to demonstrate that all these justifications are unsatisfactory since they entail counterintuitive implications in cases involving fetuses and newborns. We then suggest another justification for the relevance of age based on the Time-Relative Interest Account of the (...)
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  12. Resource Scarcity in Austere Environments: An Ethical Examination of Triage and Medical Rules of Eligibility.Sheena M. Eagan & Daniel Messelken (eds.) - 2023 - Springer Verlag.
    This book focuses on resource allocation in military and humanitarian medicine during times of scarcity and austerity. It is in these times that health systems bend, break, and even collapse and where resource allocation becomes a paramount concern and directly impacts clinical decision-making. Such times are challenging and this book covers this very important, yet, scarcely researched topic within the field of bioethics. This work brings together experts and practitioners in the fields of military health care, philosophy, ethics, and other (...)
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  13. Introduction and Synopsis.Sheena M. Eagan & Daniel Messelken - 2023 - In Sheena M. Eagan & Daniel Messelken (eds.), Resource Scarcity in Austere Environments: An Ethical Examination of Triage and Medical Rules of Eligibility. Springer Verlag. pp. 1-16.
    Modern medicine consumes vast amounts of resources, ranging from human to technological and financial. In a well-functioning and well-equipped health system, resource allocation considerations rarely impact clinical decision-making as all patients that need care will (eventually) receive it. In light of this, health care providers (HCPs) are often taught to focus on the patient in front of them, driven by a type of patient-centred ethics (of care) that prioritizes the individual person’s well-being above the aggregate. Informed by the principle of (...)
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  14. The shared ethical framework to allocate scarce medical resources: a lesson from COVID-19.Ezekiel J. Emanuel & Govind Persad - 2023 - The Lancet 401 (10391):1892–1902.
    The COVID-19 pandemic has helped to clarify the fair and equitable allocation of scarce medical resources, both within and among countries. The ethical allocation of such resources entails a three-step process: (1) elucidating the fundamental ethical values for allocation, (2) using these values to delineate priority tiers for scarce resources, and (3) implementing the prioritisation to faithfully realise the fundamental values. Myriad reports and assessments have elucidated five core substantive values for ethical allocation: maximising benefits and minimising harms, mitigating unfair (...)
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  15. Medical Rules of Eligibility – Can Preferential Medical Treatment Provisions Be Ethically Justified?Daniel Messelken - 2023 - In Sheena M. Eagan & Daniel Messelken (eds.), Resource Scarcity in Austere Environments: An Ethical Examination of Triage and Medical Rules of Eligibility. Springer Verlag. pp. 133-153.
    In emergency situations and while medical resources are sufficient, doctors are expected to prioritize and treat patients according to medical criteria only. In MASSCAL situations and when medical resources become insufficient, patient selection and prioritization changes. Rules of triage are applied with the aim of getting the best result possible under the circumstances, e.g., saving the largest number; collective health outweighs individual health. Still, according to the standard ethical principles, non-medical criteria should never influence the doctors’ decision of who will (...)
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  16. Fair domestic allocation of monkeypox virus countermeasures.Govind Persad, R. J. Leland, Trygve Ottersen, Henry S. Richardson, Carla Saenz, G. Owen Schaefer & Ezekiel J. Emanuel - 2023 - Lancet Public Health 8 (5):e378–e382.
    Countermeasures for mpox (formerly known as monkeypox), primarily vaccines, have been in limited supply in many countries during outbreaks. Equitable allocation of scarce resources during public health emergencies is a complex challenge. Identifying the objectives and core values for the allocation of mpox countermeasures, using those values to provide guidance for priority groups and prioritisation tiers, and optimising allocation implementation are important. The fundamental values for the allocation of mpox countermeasures are: preventing death and illness; reducing the association between death (...)
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  17. Clarifying the Discussion on Prioritization and Discrimination in Healthcare.Joona Räsänen - 2023 - Cambridge Quarterly of Healthcare Ethics 32 (2):139-140.
    Discrimination is an important real-life issue that affects many individuals and groups. It is also a fruitful field of study that intersects several disciplines and methods. This Special Section brings together papers on discrimination and prioritization in healthcare from leading scholars in bioethics and closely related fields.
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  18. Equitable global allocation of monkeypox vaccines.G. Owen Schaefer, Ezekiel J. Emanuel, Caesar A. Atuire, R. J. Leland, Govind Persad, Henry S. Richardson & Carla Saenz - 2023 - Vaccine 41 (48):7084-7088.
    With the world grappling with continued spread of monkeypox internationally, vaccines play a crucial role in mitigating the harms from infection and preventing spread. However, countries with the greatest need - particularly historically endemic countries with the highest monkeypox case-fatality rates - are not able to acquire scarce vaccines. This is unjust, and requires rectification through equitable allocation of vaccines globally. We propose applying the Fair Priority Model for such allocation, which emphasizes three key principles: 1) preventing harm; 2) prioritizing (...)
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  19. Involuntary Withdrawal: A Bridge Too Far?Joanna Smolenski - 2023 - Clinical Ethics Case Studies, Hastings Bioethics Forum.
    RD, a 32-year-old male, was admitted to the hospital with hypoxic COVID pneumonia–a potentially life-threatening condition characterized by dangerously low levels of oxygen in the body- during one of the pandemic’s surges. While RD’s age gave the clinical team hope for his prognosis, his ability to recover was complicated by his being unvaccinated and having multiple comorbidities, including diabetes and obesity. His condition worsened to the point that he required extracorporeal membrane oxygenation (ECMO), a machine that maintains the functioning of (...)
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  20. Voluntariness or legal obligation? An ethical analysis of two instruments for fairer global access to COVID-19 vaccines.Katja Voit, Cristian Timmermann, Marcin Orzechowski & Florian Steger - 2023 - Frontiers in Public Health 11:995683.
    Introduction: There is currently no binding, internationally accepted and successful approach to ensure global equitable access to healthcare during a pandemic. The aim of this ethical analysis is to bring into the discussion a legally regulated vaccine allocation as a possible strategy for equitable global access to vaccines. We focus our analysis on COVAX (COVID-19 Vaccines Global Access) and an existing EU regulation that, after adjustment, could promote global vaccine allocation. -/- Methods: The main documents discussing the two strategies are (...)
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  21. "Where you live should not determine whether you live". Global justice and the distribution of COVID-19 vaccines.Göran Collste - 2022 - Ethics and Global Politics 15 (2):43-54.
    In 2020, the world faced a new pandemic. The corona infection hit an unprepared world, and there were no medicines and no vaccines against it. Research to develop vaccines started immediately and in a remarkably short time several vaccines became available. However, despite initiatives for global equitable access to COVID-19 vaccines, vaccines have so far become accessible only to a minor part of the world population. In this article, I discuss the global distribution of COVID-19 vaccines from an ethical point (...)
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  22. The Prospects for ‘Prospect Utilitarianism’.Ben Davies - 2022 - Utilitas 34 (3):335-343.
    Hun Chung argues for a theory of distributive justice – ‘prospect utilitarianism’ – that overcomes two central problems purportedly faced by sufficientarianism: giving implausible answers in ‘lifeboat cases’, where we can save the lives of some but not all of a group, and failing to respect the axiom of continuity. Chung claims that prospect utilitarianism overcomes these problems, and receives empirical support from work in economics on prospect theory. This article responds to Chung's criticisms of sufficientarianism, showing that they are (...)
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  23. Is regulatory innovation fit for purpose? A case study of adaptive regulation for advanced biotherapeutics.Giovanni De Grandis - 2022 - Regulation and Governance 16.
    The need to better balance the promotion of scientific and technological innovation with risk management for consumer protection has inspired several recent reforms attempting to make regulations more flexible and adaptive. The pharmaceutical sector has a long, established regulatory tradition, as well as a long history of controversies around how to balance incentives for needed therapeutic innovations and protecting patient safety. The emergence of disruptive biotechnologies has provided the occasion for regulatory innovation in this sector. This article investigates the regulation (...)
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  24. We Should Not Use Randomization Procedures to Allocate Scarce Life-Saving Resources.Roberto Fumagalli - 2022 - Public Health Ethics 15 (1):87-103.
    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 RAND to allocate SLSR in fewer cases than their proponents maintain and that the relevant decision-makers should typically allocate SLSR directly to the individuals with the strongest claims (...)
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  25. A Fuzzy-Cognitive-Maps Approach to Decision-Making in Medical Ethics.Alice Hein, Lukas J. Meier, Alena Buyx & Klaus Diepold - 2022 - 2022 IEEE International Conference on Fuzzy Systems (FUZZ-IEEE).
    Although machine intelligence is increasingly employed in healthcare, the realm of decision-making in medical ethics remains largely unexplored from a technical perspective. We propose an approach based on fuzzy cognitive maps (FCMs), which builds on Beauchamp and Childress’ prima-facie principles. The FCM’s weights are optimized using a genetic algorithm to provide recommendations regarding the initiation, continuation, or withdrawal of medical treatment. The resulting model approximates the answers provided by our team of medical ethicists fairly well and offers a high degree (...)
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  26. Existing Ethical Tensions in Xenotransplantation.L. Syd M. Johnson - 2022 - Cambridge Quarterly of Healthcare Ethics 31 (3):355-367.
    The genetic modification of pigs as a source of transplantable organs is one of several possible solutions to the chronic organ shortage. This paper describes existing ethical tensions in xenotransplantation (XTx) that argue against pursuing it. Recommendations for lifelong infectious disease surveillance and notification of close contacts of recipients are in tension with the rights of human research subjects. Parental/guardian consent for pediatric xenograft recipients is in tension with a child’s right to an open future. Individual consent to transplant is (...)
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  27. Value assessment frameworks: who is valuing the care in healthcare?Jonathan Anthony Michaels - 2022 - Journal of Medical Ethics 48 (6):419-426.
    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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  28. Equal Protection and Scarce Therapies: The Role of Race, Sex, and Other Protected Classifications.Govind Persad - 2022 - Smu Law Review Forum 75:226.
    The allocation of scarce medical treatments, such as antivirals and antibody therapies for COVID-19 patients, has important legal dimensions. This Essay examines a currently debated issue: how will courts view the consideration of characteristics shielded by equal protection law, such as race, sex, age, health, and even vaccination status, in allocation? Part II explains the application of strict scrutiny to allocation criteria that consider individual race, which have been recently debated, and concludes that such criteria are unlikely to succeed under (...)
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  29. COVID-19 Vaccine Refusal and Fair Allocation of Scarce Medical Resources.Govind Persad & Emily A. Largent - 2022 - JAMA Health Forum 3 (4):e220356.
    When hospitals face surges of patients with COVID-19, fair allocation of scarce medical resources remains a challenge. Scarcity has at times encompassed not only hospital and intensive care unit beds—often reflecting staffing shortages—but also therapies and intensive treatments. Safe, highly effective COVID-19 vaccines have been free and widely available since mid-2021, yet many Americans remain unvaccinated by choice. Should their decision to forgo vaccination be considered when allocating scarce resources? Some have suggested it should, while others disagree. We offer a (...)
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  30. Fair access to scarce medical capacity for non-covid-19 patients: a role for reserves.Govind Persad, Parag A. Pathak, Tayfun Sonmez & M. Utku Unver - 2022 - Bmj:10.1136/bmj.o276.
    As hospitals in the US and elsewhere fill again with patients with covid-19, discussions about how to fairly allocate scarce medical resources have come to the fore once again. One frequently voiced concern is that non-covid-19 patients with urgent health needs are facing indefinitely postponed surgeries, long-distance hospital transfers, or even are unable to access medical treatment. In our view, a reserve or categorised priority system could help. It could be used to fairly distribute scarce medical capacity—such as staffing, physical (...)
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  31. Why we should stop using animal-derived products on patients without their consent.Daniel Rodger - 2022 - Journal of Medical Ethics 48 (10):702-706.
    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. First, I argue that using animal-derived medical products on patients without their informed consent undermines respect for their autonomy. Second, it risks causing nontrivial psychological harm. Third, it is morally inconsistent to respect (...)
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  32. Rare and common diseases should be treated equally and why the article by de Magalhaes somewhat misses its’ mark.Lars Sandman - 2022 - Journal of Medical Ethics 48 (2):97-98.
    In the article Should rare diseases get special treatment? by Monica Q F de Magalhaes,1 it is argued that rarity is not a morally relevant feature to consider in prioritising treatment in healthcare, but severity is. A central conclusion in the article is that severity rather than prevalence should guide different cost-effectiveness thresholds. Hence, I take it, she answers no to the question in her own heading. I agree with all of this—and with most of her other arguments and conclusions (...)
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  33. COVID-19 vaccine boosters for all adults: An optimal U.s. approach?Ameet Sarpatwari, Ankur Pandya, Emily P. Hyle & Govind Persad - 2022 - Annals of Internal Medicine 175 (2):280-282.
    By 20 October 2021, the U.S. Food and Drug Administration (FDA) had amended its Emergency Use Authorizations for immunocompetent adults who previously received the Pfizer-BioNTech, Moderna, or Johnson & Johnson COVID-19 vaccines. For the 2-dose Pfizer-BioNTech and Moderna vaccines, the FDA permitted a single booster dose for adults aged 65 years or older and adults aged 18 to 64 years at high-risk for severe COVID-19 or at high risk for occupational or institutional COVID-19 exposure. For the single-dose Johnson & Johnson (...)
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  34. Dose optimisation and scarce resource allocation: two sides of the same coin.Garth Strohbehn, Govind Persad, William F. Parker & Srinivas Murthy - 2022 - BMJ Open 12 (10):e063436.
    Objective: A deep understanding of the relationship between a scarce drug's dose and clinical response is necessary to appropriately distribute a supply-constrained drug along these lines. Summary of key data: The vast majority of drug development and repurposing during the COVID-19 pandemic – an event that has made clear the ever-present scarcity in healthcare systems –has been ignorant of scarcity and dose optimisation's ability to help address it. Conclusions: Future pandemic clinical trials systems should obtain dose optimisation data, as these (...)
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  35. A Multicenter Weighted Lottery to Equitably Allocate Scarce COVID-19 Therapeutics.D. B. White, E. K. McCreary, C. H. Chang, M. Schmidhofer, J. R. Bariola, N. N. Jonassaint, Parag A. Pathak, G. Persad, R. D. Truog, T. Sonmez & M. Utku Unver - 2022 - American Journal of Respiratory and Critical Care Medicine 206 (4):503–506.
    Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino and (...)
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  36. Value choices in European COVID-19 vaccination schedules: how vaccination prioritization differs from other forms of priority setting.Karolina Wiśniowska, Tomasz Żuradzki & Wojciech Ciszewski - 2022 - Journal of Law and the Biosciences 9 (2):lsac026.
    With the limited initial availability of COVID-19 vaccines in the first months of 2021, decision-makers had to determine the order in which different groups were prioritized. Our aim was to find out what normative approaches to the allocation of scarce preventive resources were embedded in the national COVID-19 vaccination schedules. We systematically reviewed and compared prioritization regulations in 27 members of the European Union, the United Kingdom, and Israel. We differentiated between two types of priority categories: groups that have increased (...)
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  37. Affirmative action in healthcare resource allocation: Vaccines, ventilators and race.Hazem Zohny, Ben Davies & Dominic Wilkinson - 2022 - Bioethics 36 (9):970-977.
    This article is about the potential justification for deploying some form of affirmative action (AA) in the context of healthcare, and in particular in relation to the pandemic. We call this Affirmative Action in healthcare Resource Allocation (AARA). Specifically, we aim to investigate whether the rationale and justifications for using prioritization policies based on race in education and employment apply in a healthcare setting, and in particular to the COVID-19 pandemic. We concentrate in this article on vaccines and ventilators because (...)
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  38. 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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  39. 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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  40. Approaches to critical care resource allocation and triage during the COVID-19 pandemic: an examination from a developing world perspective.Saurav Basu - 2021 - Journal of Medical Ethics and History of Medicine 14.
    The distribution of scarce critical care resources during public health emergencies in an ethically justified manner has been widely acknowledged as a major bioethics concern. The Center for Disease Control (CDC) recommends that critical care allocation during a pandemic emergency should uphold basic biomedical principles through maintenance of procedural justice which requires decision-making that is consistent, impartial, neutral, and nondiscriminatory. During the current COVID-19 pandemic, health systems, even in developed countries with robust existing health infrastructure, have experienced sustained demands that (...)
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  41. Crisis Nationalism: To What Degree Is National Partiality Justifiable during a Global Pandemic?Eilidh Beaton, Mike Gadomski, Dylan Manson & Kok-Chor Tan - 2021 - Ethical Theory and Moral Practice 24 (1):285-300.
    Are countries especially entitled, if not obliged, to prioritize the interests or well-being of their own citizens during a global crisis, such as a global pandemic? We call this partiality for compatriots in times of crisis “crisis nationalism”. Vaccine nationalism is one vivid example of crisis nationalism during the COVID-19 pandemic; so is the case of the US government’s purchasing a 3-month supply of the global stock of the antiviral Remdesivir for domestic use. Is crisis nationalism justifiable at all, and, (...)
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  42. 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 patients 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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  43. 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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  44. ‘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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  45. 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 (‘the authors’) does not explicitly mention Rawls’s work on this (...)
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  46. Responsibility and the recursion problem.Ben Davies - 2021 - Ratio 35 (2):112-122.
    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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  47. 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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  48. Priority, Ethical Principle, and Allocation of Scarce Medical Resources. Di Wu - 2021 - Studies in Dialectics of Nature 11 (37):62-68.
    Aiming at the allocation of scarce medical resources, Immanuel and other scholars have put forward a set of influential ethical values and guiding principles. It assigns the priority of resource allocation to those whose lives can be saved and maximized, those who can bring the greatest instrumental value, and those who are the worse off. For other members of society, random selection under the same conditions is adopted. Following the Rawlsian "lexical order, lexicographical" rule, this priority arrangement requires that the (...)
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  49. What are the obligations of pharmaceutical companies in a global health emergency?Ezekiel J. Emanuel, Allen Buchanan, Shuk Ying Chan, Cécile Fabre, Daniel Halliday, Joseph Heath, Lisa Herzog, R. J. Leland, Matthew S. McCoy, Ole F. Norheim, Carla Saenz, G. Owen Schaefer, Kok-Chor Tan, Christopher Heath Wellman, Jonathan Wolff & Govind Persad - 2021 - Lancet 398 (10304):1015.
    All parties involved in researching, developing, manufacturing, and distributing COVID-19 vaccines need guidance on their ethical obligations. We focus on pharmaceutical companies' obligations because their capacities to research, develop, manufacture, and distribute vaccines make them uniquely placed for stemming the pandemic. We argue that an ethical approach to COVID-19 vaccine production and distribution should satisfy four uncontroversial principles: optimising vaccine production, including development, testing, and manufacturing; fair distribution; sustainability; and accountability. All parties' obligations should be coordinated and mutually consistent. For (...)
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  50. Obligations in a global health emergency - Authors’ reply.Ezekiel Emanuel, Cecile Fabre, Lisa M. Herzog, Ole F. Norheim, Govind Persad, G. Owen Schaefer & Kok-Chor Tan - 2021 - Lancet 398 (10316):2072.
    In response to commentators, we argue that whether waiving patent rights will meaningfully improve access to COVID-19 vaccines for low income and middle-income countries (LMICs), particularly in the short term, is an empirical matter. We also reject preferentially allocating vaccines to countries that hosted trials because doing so unethically favours those with research infrastructure, rather than those facing the worst burdens from COVID-19.
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