Table 1 Ethical theories applicable to the allocation of scarce ICU resources during the COVID-19 pandemic
Ethical principle | Applicability to COVID-19 pandemic scenario |
|---|---|
Utilitarianism | Patients receiving priority for admission to ICU based on prognostic scoring, life-cycle considerations, societal value |
Maximize overall benefits for the maximum number of people | Contention: sacrifice of duty of care to individual to maximise public utility |
Egalitarianism | Equal treatment of competing patients by allowing rationing based on first-come, first-served basis or random selection (horizontal equity) |
Eliminating inequality and equality as the overall goal | Consideration be given first to those with greatest need (vertical equity) |
Contention: Conflict with current triaging frameworks, potential to deprive others who may benefit | |
Libertarianism | Patients can access private health care if they have the means to do so |
Resource distribution according to market principles | |
Communitarianism | Sharing of frameworks with greater society and ensuring public support and understanding of triage policies |
Respect for communities, societal order and what binds them |