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Allocate scarce resources in clinical settings

When resources used in clinical settings are scarce (e.g., personal protective gear, treatments, equipment), devise a method for a just distribution.

  • As part of pandemic influenza planning, policymakers should establish a process for setting priorities and promoting equitable access. WHO Ethics in Pandemic Flu
  • Facilitate access to the highest level of treat­ment possible given available resources, with careful attention to the needs of all populations. WHO Ethics in Pandemic Flu
  • The distribution of goods should be guided by criteria specified well in advance of any need to apply them. CDC Ethics in Pandemic Flu
  • The primary goals of the distribution system should be clearly specified. CDC Ethics in Pandemic Flu
  • An effective communications strategy should be developed to ensure a transparent priority setting process. University of Toronto
  • Governments and the health care sector should publicize a clear rationale for giving priority access to health care services, including antivirals and vaccines, to particular groups, such as front-line health workers and those in emergency services. The decision makers should initiate and facilitate constructive public discussion about these choices. University of Toronto
  • Governments and the health care sector should engage stakeholders in determining what criteria should be used to make resource allocation decisions, should ensure that clear rationales for allocation decisions are publicly accessible, and should provide a justification for any deviation from the pre-determined criteria. University of Toronto
  • Promote openness among the government, nongovernmental entities, and the public regarding resource allocation and performance improvement. APHA Code of Ethics, 4.12.3.
  • Provide clinicians with clear and transparent screening and treatment protocols in line with the latest guidance from WHO or relevant na­tional health authorities. WHO Ethics in Pandemic Flu
  • [Healthcare institutions] should ensure that providers understand policies regarding the prioritization and utilization of antivirals and vaccines. Indiana University
  • Incorporate mechanisms that: ensure that the guidelines and protocols are followed; enable clinicians to inform health authorities when clinical experience suggests the need for revisions of the protocols; and enable clinicians to take part in the process of updating guidelines and protocols as the pandemic progresses. WHO Ethics in Pandemic Flu
  • Governments and the health care sector should ensure that there are formal mechanisms in place for stakeholders to bring forward new information, to appeal or raise concerns about particular allocation decisions, and to resolve disputes. University of Toronto
  • Propose prioritization criteria related to the maintenance of a functioning health-care sys­tem as needed in a crisis situation. WHO Ethics in Pandemic Flu
  • Consider giving priority to: essential health-care workers, other workers who provide life-saving services, workers who provide critical services nec­essary for society to function as normally as possible. WHO Ethics in Pandemic Flu
  • [When a vaccine becomes available, consider] prioritizing health-care workers and other essen­tial service providers to help sustain the health-care system. WHO Ethics in Pandemic Flu
  • Health care workers, who bear a large portion of the burden of caring for the afflicted, are prioritized for protective equipment and vaccinations in order to minimize their increased risk of infection. Indiana University
  • [Consider] the likelihood that an individual with disease will experience a medical benefit if provided treatment.WHO Ethics in Pandemic Flu
  • [When a vaccine becomes available, consider] prioritizing persons at increased risk of death if infected. WHO Ethics in Pandemic Flu
  • Plans should address the rules for terminating treatment of patients suffering from pandemic influenza and other diseases and conditions, so that other patients can have access to scarce resources (such as mechanically-assisted ventilation). WHO Ethics in Pandemic Flu
  • Plans should address the importance of providing palliative/support­ive care to all persons who need it. WHO Ethics in Pandemic Flu
  • Less drastic methods of preserving scarce resources, such as canceling elective surgeries, are recommended prior to the implementation of rationing procedures. As need becomes greater and resources become more scarce, the policy’s inclusion and exclusion criteria become more restrictive, reflecting the severity of the situation. Indiana University
  • [Consider] the likelihood that an individual at risk of in­fection will become infected/ill if prophylaxis is not provided. WHO Ethics in Pandemic Flu
  • [Consider] the likelihood that an infected individual will infect other persons if not given access to treatment or prophylaxis and infection control measures. WHO Ethics in Pandemic Flu
  • [When a vaccine becomes available, consider] prioritizing groups of people known to be cen­tral to spreading infection or “super-spreaders” (if this strategy is expected to be effective). WHO Ethics in Pandemic Flu
  • Age-based prioritization criteria should be adopted only after wide public consultation. Such criteria should rely on broad life stages, rather than rank­ing individuals based on differences of only a few years. WHO Ethics in Pandemic Flu
  • Policymakers should ensure that criteria for prior­ity setting do not discriminate against individuals based on inappropriate characteristics, including but not limited to gender, race and ethnicity, religion, political affiliation, national origin, or social or economic status. WHO Ethics in Pandemic Flu
  • [When a vaccine becomes available, consider] prioritizing children and young adults based on the fair innings argument. WHO Ethics in Pandemic Flu
  • Some theoretical distribution criteria that would generally not be ethically supported are: to each according to purchasing power; to each according to what he or she deserves; first come, first served; race, ethnicity, religious belief, gender, sexual orientation, or IQ. CDC Ethics in Pandemic Flu
  • Where the primary objective is to preserve the function of society, it is necessary to identify certain individuals and groups of persons as ‘key’ to the preservation of society and to accord to them a high priority for the distribution of certain goods such as vaccines and antiviral drugs. CDC Ethics in Pandemic Flu
  • Ensure that resulting interventions do not have a disproportionately negative impact on minority or otherwise vulnerable populations (including children and elders) and that there is an effort to enhance the resilience of populations and ecosystems to prevent future harm. APHA Code of Ethics, 4.2.9.
  • Recognize and act upon the fact that the ethical obligation to provide access to health care is not limited to persons with citizen status only. APHA Code of Ethics, 4.7.6.
  • Equal opportunity to access resources should be assured to those within agreed upon priority groups. CDC Ethics in Pandemic Flu
  • It is also strongly recommended that hospitals in certain regions abide by the same triage and altered standards of care protocols in order to ensure a more fair distribution of scarce resources. Indiana University


What is Pandemic Ethics?

A pandemic is pervasive in scope and touches virtually every human-made system. In this dashboard, we focus on ethics in a government’s or an employer’s actions in a pandemic.

Public health ethics addresses the relationship between those governing or administrating and the population or employees they serve. They are best summarized by the Public Health Code of Ethics of the American Public Health Association.

Contact Jim Thomas