Public attitudes toward allocating scarce resources in the COVID-19 pandemic

Abstract

The general public is subject to triage policies that allocate scarce lifesaving resources during the COVID-19 pandemic, one of the worst public health emergencies in the past 100 years. However, public attitudes toward ethical principles underlying triage policies used during this pandemic are not well understood. Three experiments (preregistered; online samples; N = 1,868; U.S. residents) assessed attitudes toward ethical principles underlying triage policies. The experiments evaluated assessments of utilitarian, egalitarian, prioritizing the worst-off, and social usefulness principles in conditions arising during the COVID-19 pandemic, involving resource scarcity, resource reallocation, and bias in resource allocation toward at-risk groups, such as the elderly or people of color. We found that participants agreed with allocation motivated by utilitarian principles and prioritizing the worst-off during initial distribution of resources and disagreed with allocation motivated by egalitarian and social usefulness principles. At reallocation, participants agreed with giving priority to those patients who received the resources first. Lastly, support for utilitarian allocation varied when saving the greatest number of lives resulted in disadvantage for at-risk or historically marginalized groups. Specifically, participants expressed higher levels of agreement with policies that shifted away from maximizing benefits to one that assigned the same priority to members of different groups if this mitigated disadvantage for people of color. Understanding these attitudes can contribute to developing triage policies, increase trust in health systems, and assist physicians in achieving their goals of patient care during the COVID-19 pandemic.

Which factors should be included in triage? An online survey of the attitudes of the UK general public to pandemic triage dilemmas

“… 35 It is, however, broadly consistent with Buckwalter and Peterson’s survey which found agreement with a utilitarian triage policy even if it disadvantaged older patients. 34 It is also consistent with community studies that mentioned maximising numbers of life-years saved, 20 33 as well as recent study using veil-of-ignorance reasoning in COVID-19 ventilator dilemmas. 36 While this latter study found older participants do not initially favour prioritising the young, they do after imagining that they did not know if they would be the younger or older patient requiring a ventilator to survive.…”

“…Participants indicated support for triage policies that aimed to save the most lives (‘utilitarian’ policy) or treat the sickest patients (labelled ‘prioritising the worst off’), but disagreed with policies that treated patients in order of arrival (‘egalitarian’) or prioritised based on social importance. 34 However, the results of Buckwalter and Peterson’s study are hard to compare with our own. Participants in that study were asked to endorse general policies, but not presented with specific cases of competing patients.…”

“…It is somewhat in contrast to Buckwalter and Peterson, who found relative ambivalence for triage policies that would reallocate treatment in order to save more lives. 34 In the Maryland and Texas community studies, a number of participants expressed concern about withdrawal of a ventilator in order to benefit another patient. Nevertheless, 62% of participants in both studies accepted that there were circumstances where this was acceptable.…”

The perceived deservingness of COVID-19 healthcare in the Netherlands: a conjoint experiment on priority access to intensive care and vaccination

“…Similar ethical debates took place about the allocation of a scarce first release of COVID-19 vaccines, as early production capacity is limited [ 5 ]. These ethical guidelines often converge in the utilitarian principle of maximizing benefits [ 6 ] to “save the greatest number of lives or preserve the largest amount of life-years among treated patients” [ 7 ].…”

“…In this contribution, we ask public opinion, representative of the Dutch population, who is perceived as more deserving of priority (a) over ICU care, and (b) in COVID-19 vaccination. Doing so, we extend a growing body of publications focused on ICU triage dilemmas [ 7 , 14 ] by including preferences towards the allocation of scarce vaccines, and by zooming in on the Netherlands.…”