Table 1 Monstic principles for allocating scarce resources.
From: Allocating scarce medical resources during armed conflict: ethical issues
Allocation principle | Advantages | Disadvantages | Examples of use |
|---|---|---|---|
Treating people equally | |||
Lottery | Hard to corrupt; little information about recipients needed | Ignores other relevant principles | Military draft; schools; vaccination |
First-come, first-served | Protects existing doctor-patient relationships; little information about recipients needed | Favors wealthy; powerful, and well-connected; ignores other relevant principles | Intensive Care Unit (ICU) beds; part of organ allocation |
Favoring the worst-off: prioritiarianism | |||
Sickest first | Aids those who are suffering right now; appeals to “rule of rescue”; makes sense in temporary scarcity; proxy for being worst off overall | Surreptitious use of prognosis; ignores needs of those who will become sick in future; might falsely assume temporary scarcity; leads people receiving interventions only after prognosis deteriorates; ignores other relevant principles | Emergency rooms; part of organ allocation |
Youngest first | Benefits those who have had least life; prudent planners have an interest in living to old age | Undesirable priority to infants over adolescent and young adults; ignores other relevant principles | New National Vaccine Advisory Committee/Advisory Committee on Immunization Practices (NVAC/ACIP) pandemic flu vaccine proposal |
Maximizing total benefit: utilitarianism | |||
Number of lives saved | Saves more lives, benefiting the greatest number; avoids need for comparative judgments about quality or other aspects of lives | Ignores other relevant principles | Past ACIP/NVAC pandemic flu vaccine; bioterrorism response policy; disaster triage |
Prognosis or life-years saved | Maximizes life-years produced | Ignores other relevant principles, particularly distribute principles | Penicillin allocation; traditional military triage (prognosis) and disaster triage (life-years saved) |
Promoting and rewarding social usefulness | |||
Instrumental value | Helps promote other important values; future oriented | Vulnerable to abuse through choice of prioritized occupations or activities; can direct resources away from health needs | Past and current NVAC/ACIP pandemic flu vaccine policy |
Reciprocity | Rewards those who implemented important values; past oriented | Vulnerable to abuse; can direct health consequences; intrusive assessment process | Some organ donation polices |