The Intensive Care Lifeboat: a survey of lay attitudes to rationing dilemmas in neonatal intensive care.
Resuscitation and treatment of critically ill newborn infants is associated with relatively high mortality, morbidity and cost. Guidelines relating to resuscitation have traditionally focused on the best interests of infants. There are, however, limited resources available in the neonatal intensive care unit (NICU), meaning that difficult decisions sometimes need to be made. This study explores the intuitions of lay people (non-health professionals) regarding resource allocation decisions in the NICU.



The study design was a cross-sectional quantitative survey, consisting of 20 hypothetical rationing scenarios. There were 119 respondents who entered the questionnaire, and 109 who completed it. The respondents were adult US and Indian participants of the online crowdsourcing platform Mechanical Turk. Respondents were asked to decide which of two infants to treat in a situation of scarce resources. Demographic characteristics, personality traits and political views were recorded. Respondents were also asked to respond to a widely cited thought experiment involving rationing.



The majority of respondents, in all except one scenario, chose the utilitarian option of directing treatment to the infant with the higher chance of survival, higher life expectancy, less severe disability, and less expensive treatment. As discrepancy between outcomes decreased, however, there was a statistically significant increase in egalitarian responses and decrease in utilitarian responses in scenarios involving chance of survival (P = 0.001), life expectancy (P = 0.0001), and cost of treatment (P = 0.01). In the classic 'lifeboat' scenario, all but two respondents were utilitarian.



This survey suggests that in situations of scarcity and equal clinical need, non-health professionals support rationing of life-saving treatment based on probability of survival, duration of survival, cost of treatment or quality of life. However, where the difference in prognosis or cost is very small, non-health professionals preferred to give infants an equal chance of receiving treatment.
Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.|Monash Hospital, Clayton, VIC, Australia.
C
C
Arora
Oxford Uehiro Centre for Practical Ethics, University of Oxford, Suite 8, Littlegate House, St Ebbes St, Oxford, OX1 1PT, UK.
J
J
Savulescu
Oxford Uehiro Centre for Practical Ethics, University of Oxford, Suite 8, Littlegate House, St Ebbes St, Oxford, OX1 1PT, UK.
H
H
Maslen
School of Philosophical, Historical and International Studies, Monash University, Melbourne, VIC, Australia.
M
M
Selgelid
Oxford Uehiro Centre for Practical Ethics, University of Oxford, Suite 8, Littlegate House, St Ebbes St, Oxford, OX1 1PT, UK. dominic.wilkinson@philosophy.ox.ac.uk.|John Radcliffe Hospital, Oxford, UK. dominic.wilkinson@philosophy.ox.ac.uk.
D
0000-0003-3958-8633
D
Wilkinson
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003657:Decision Making / Q000941:ethics*; D005260:Female; D015276:Health Care Rationing / Q000941:ethics*; D006295:Health Resources; D006801:Humans; D007194:India; D015931:Intensive Care, Neonatal / Q000941:ethics*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012151:Resuscitation; D011795:Surveys and Questionnaires; D013850:Thinking; D014481:United States; D055815:Young Adult
Infant; Intensive care units; Medical ethics; Neonatal; Newborn; Questionnaires; Resource allocation; Resuscitation