title: Principles for allocation of scarce medical interventions.
abstract: Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system-the complete lives system-which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.
authors.affiliation: Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Govind
authors.initials: G
authors.lastname: Persad
authors.forename: Alan
authors.initials: A
authors.lastname: Wertheimer
authors.forename: Ezekiel J
authors.initials: EJ
authors.lastname: Emanuel
mesh_terms: D000367:Age Factors; D004992:Ethics, Medical; D015276:Health Care Rationing / Q000941:ethics / Q000379:methods; D006292:Health Priorities / Q000941:ethics*; D006801:Humans; D009014:Morals; D018579:Patient Selection / Q000941:ethics*; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D040841:Resource Allocation / Q000941:ethics / Q000379:methods