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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