Question: What ethical judgements are made in reference to how scarce resources are allocated?

Answer passage (source: WHO):
page_title: Q&A: Ethics and COVID-19: resource allocation and priority setting
section_headers: How should decision-makers make considered ethical judgements about these matters, given the likelihood that there will not be enough of a resource? Who should be involved in decision-making on scarce resources?
section_content: For most decisions, multiple ethical values and principles will be relevant to
deliberations about how to allocate resources. This is likely to generate some
disagreement, because different people may weigh the values differently. Some
may prioritize equality while others might put more emphasis on best outcomes
or prioritization of the worst-off. For this reason, it is imperative that the
different values be weighed and applied to specific allocation issues using a
fair process.
A fair process for allocating scarce resources must promote certain ethical
values:

Transparency. In a transparent process, the decisions and their justifications should be made public. This means that the population should be informed about the criteria guiding the decisions.
Inclusiveness. Those affected by allocation decisions – including individuals, communities or countries – should be able to exert at least some influence over the decision-making process as well as the decision itself. This also means that decisions 4 should be open to challenge and potentially revisable, perhaps through an appeal process. 
Consistency. Decisions should be consistent so that all persons in the same categories are treated in the same way. This means that favouritism towards one’s own family, religious or political compatriots, or otherwise, is not appropriate. All forms of corruption that are at variance with this principle should be challenged and condemned. 
Accountability. Those making decisions about allocation must be accountable for those decisions – that is, they should justify their decisions and be held responsible for them. A fair process means that allocation decisions should not be made by individuals, by individual pharmaceutical companies, or, in the case of allocation between countries, by a single country. Resources such as vaccines and therapies should not be stockpiled outside the system of fair allocation.

The fair allocation of resources is one that is valuable in itself precisely
because it is fair. However, it may also be valuable because a fair system
engenders solidarity and trust, which are vital to the successful and
sustained collective response necessary for dealing effectively with any
outbreak.

Reviewer feedback on this answer:
Lists ethical principles that should be weighed when allocating scarce resources.
The answer is a detailed response to the question.

Reviewer ratings:
Excellent
Excellent

Answer passage (source: WHO):
page_title: Q&A: Ethics and COVID-19: resource allocation and priority setting
section_headers: Can I adapt previous frameworks for pandemic influenza to guide resource allocation for COVID-19?
section_content: Many ethical frameworks have been produced for resource allocation, some of
which have been included in pandemic plans. Those frameworks provide useful
guidance in the current scenario. Yet, when applying them, we must take into
account the type of health care resource, the context, and the stage of the
pandemic. That is, while the ethical principles that apply to resource
allocation might be the same in different pandemics, they can lead to
different decisions, given contextual circumstances. For example, this
pandemic appears to significantly impact older adults (those 60 years of age
or older), and such characteristics are relevant to shaping priorities for the
allocation of resources during COVID-19. As a result, it may be inappropriate
to use critical care triage guidelines that have age cut-offs that
deprioritize or exclude those aged over 60 years.
When applying ethical guidelines for resource allocation, we should consider
the extent to which resources are overwhelmed in the current context. It would
be inappropriate, for instance, to exclude population groups from being
allocated a resource (for example, ventilators) at the outset of a pandemic
when capacity remains. When resources are scarce, though – when there is an
insufficient supply to meet everyone’s needs – resource allocation should be
guided by well established, broadly applicable ethical principles, unless
there are characteristics of the outbreak that justify different courses of
action. Irrelevant characteristics of populations within countries, such as
ethnicity, race or creed, should play no role in any resource allocation in
any pandemic. This reflects our commitment to treating people with equal
respect.

Reviewer feedback on this answer:
Detailed discussion of relevant ethical factors when allocating scarce resources.
The answer is a detailed response to the question.

Reviewer ratings:
Excellent
Excellent

Answer passage (source: WHO):
page_title: Q&A: Ethics and COVID-19: resource allocation and priority setting
section_headers: What is the basis for deciding who should have priority access to scarce resources?
section_content: The ethical basis for deciding which individuals or groups might be
prioritized, including the principles to be applied, are presented in the
below table:
Ethical considerations when deciding who to prioritize
Principle|  Description|  Practice implication
---|---|---
Equality|
Each person’s interest should count equally unless there are good reasons that
justify the differential prioritization of resources.
Irrelevant characteristics of individuals, such as race, ethnicity, creed,
ability or gender, should not serve arbitrarily as the basis for the
differential allocation of resources.
This principle can be used to justify the allocation of resources by a lottery
– that is, randomly by chance – or by a system of first come, first served.
|
May be most appropriate to guide the allocation of scarce resources among
individuals or populations who can be expected to derive the same benefit from
the resource, for example, vaccines among high-risk populations, or
ventilators among those with similar clinical indicators for benefit.  
Best outcomes (utility)|
This principle can be used to justify the allocation of resources according to
their capacity to do the most good or minimize the most harm, for example,
using available resources to save the most lives possible.
|
May be most appropriate to guide the allocation of scarce resources that
confer substantially different benefits to different individuals, for example,
ventilators to those expected to derive the most benefit.  
Prioritize the worst off|
This principle can be used to justify the allocation of resources to those in
greatest medical need or those most at risk.
|
May be most appropriate to guide the allocation of resources that are designed
or intended to protect those at risk, for example, PPE for health care
workers, vaccines for those most at risk of infection and severe illness, or
those most in need, as in the case of provision of drugs in short supply to
those needing them most urgently.  
Prioritize those tasked with helping others
|
This principle can be used to justify the allocation of resources to those who
have certain skills or talents that can save many other people, or because
something is owed to them on account of their participation in helping others.
|
May be most appropriate to guide the allocation of resources to health care
workers, first responders, etc.  
Allocation principles may be relevant or justified at different stages of
resource scarcity (from less scarcity to more scarcity). For example, where
little scarcity exists, the allocation of resources such as ventilators may be
most justified by the principle of first come, first served (which promotes
the value of equality). When those resources become increasingly scarce, their
allocation may be justified according to a principle that prioritizes those
most in need. With even greater scarcity, a principle that aims to maximize
benefit from the resource may be most justified. At each stage, allocation
should aim to promote equality – that is, first come, first served, or random
allocation, when no relevant factors distinguish individuals within a
particular scheme of allocation (for example, among those with similar needs,
or among those who can be expected to benefit similarly from the resources, or
among those that are at similar levels of risk).
In addition, multiple principles may be combined within an allocation scheme.
For example, an allocation scheme for PPE might find its justification in a
principle prioritizing those most at risk as well as a principle prioritizing
those tasked with helping others, which would support priority allocation of
PPE to health care workers.

Reviewer feedback on this answer:
Has a very detailed discussion of the ethical principles relevant to allocating scarce resources.
The answer is a detailed response to the question.

Reviewer ratings:
Excellent
Excellent