Long before the new coronavirus, ethicists have contemplated the moral dilemma of who is first in line when medical resources are strained, creating frameworks for apportioning treatment so that doctors and hospitals could avoid making fraught decisions on the fly.
This kind of guidance informs a variety of situations, from large-scale disasters to organ transplants. After Hurricane Katrina in 2005, for example, doctors had to decide who to evacuate first from hospitals left without power or running water as temperatures soared above 100 degrees fahrenheit.
A paper released March 2020 in the New England Journal of Medicine outlined four ethical values to guide decision-making when rationing care: maximizing the benefits of treatment, treating people equally, promoting those who are likely to help others, and giving priority to the worst off.
The Lancet, a peer-reviewed medical journal, laid out several approaches to translate these values into real life practices. While each system has its own benefits and flaws, they offer insight into the physiological and social factors that could be considered when prioritizing care.
Approaches to rationing care
A prioritarian approach treats the sickest first. In emergency care, for example, a patient suffering from a heart attack would be seen before a patient with a broken arm.