The Shared Ethical Framework to Allocate Scarce Medical Resources: A Lesson from COVID-19

Authors

Ezekiel J. Emanuel, University of Pennsylvania
Govind C. Persad, University of DenverFollow

Publication Date

6-2023

Document Type

Article

Organizational Units

Sturm College of Law

Keywords

COVID, Ethics, Health care, First responders

Abstract

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 disadvantage, equal moral concern, reciprocity, and instrumental value. These values are universal. None of the values are sufficient alone, and their relative weight and application will vary by context. In addition, there are procedural principles such as transparency, engagement, and evidence-responsiveness. Prioritising instrumental value and minimising harms during the COVID-19 pandemic led to widespread agreement on priority tiers to include health-care workers, first responders, people living in congregate housing, and people with an increased risk of death, such as older adults and individuals with medical conditions. However, the pandemic also revealed problems with the implementation of these values and priority tiers, such as allocation on the basis of population rather than COVID-19 burden, and passive allocation that exacerbated disparities by requiring recipients to spend time booking and travelling to appointments. This ethical framework should be the starting point for the allocation of scarce medical resources in future pandemics and other public health conditions. For instance, allocation of the new malaria vaccine among sub-Saharan African countries should be based not on reciprocity to countries that participated in research, but on maximally reducing serious illness and deaths, especially among infants and children.

Copyright Date

2023

File Format

application/pdf

Publication Statement

Copyright is held by Elsevier. User is responsible for all copyright compliance.

Publication Title

The Lancet

Volume

401

First Page

1892

Last Page

1902

Recommended Citation

Ezekiel J. Emanuel & Govind Persad, The Shared Ethical Framework to Allocate Scarce Medical Resources: A Lesson From COVID-19, 401 Lancet 1892 (2023).