New legal and ethical models to address allocation of scarce medical resources and services during public health emergencies

Scarcity of resources and services is likely during public health emergencies, yet the legal and ethical issues surrounding these allocation decisions have not been adequately explored. This presentation examines the legal and ethical challenges surrounding the allocation of scarce medical resources and services during public health emergencies. The presentation suggests a series of guidelines grounded in ethical theories to help resolve these challenges and explores the legal ramifications of having to prioritize access to limited resources.

The guidelines outlined in this presentation set three primary goals: minimizing morbidity and mortality, maintaining the social fabric, and ensuring justice and fairness. The guidelines further identify two criteria for allocation that clearly comport with recognized ethical principles under virtually all circumstances: prioritizing 1) those worst off according to prognosis and 2) defined essential personnel (such as critical health care workers, public safety personnel, and critical infrastructure personnel). Additional allocation criteria may be appropriate to use in some circumstances--such as using age or employing lottery or first-come, first-served approaches--but these criteria may be problematic and will almost certainly be more controversial. Finally, criteria such as broad measures of social value, demographic characteristics, or socio-economic factors are inappropriate to use to make allocation decisions. The ethical considerations and legal implications of adopting an allocation approach according to these guidelines will be developed in detail.