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Principles for allocation of scarce medical interventions
Open accessAbstract
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.
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Metadata
- Authors
- Persad, G., Wertheimer, A., & Emanuel, E. J.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Emanuel, Ezekiel J
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2009-01
- Volume
- 373
- Issue
- 9661
- Pages
- 423-431
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2133393736
- Cited by
- 929
- References
- 91
- Citations by year
- 2026: 72 · 2025: 46 · 2024: 52 · 2023: 56 · 2022: 82 · 2021: 115 · 2020: 119 · 2019: 35 · 2018: 29 · 2017: 39 · 2016: 44 · 2015: 31 · 2014: 36 · 2013: 29 · 2012: 53
- FWCI
- 47.73
- Type
- journal article
- Language
- en
- Open access
- green
- philarchive.org
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- PhilPapers (PhilPapers Foundation) (submittedVersion)
- Colorado Law Scholarly Commons (University of Colorado Colorado Springs) (submittedVersion)
- eYLS (Yale Law School) (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- U.S. Department of Health and Human Services
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Organ Donation and Transplantation
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- allocation of scarce medical resources, organ allocation, vaccine allocation, allocation principles, equal treatment, social utility, quality-adjusted life years, disability-adjusted life years, lottery allocation, prognosis, instrumental values, resource allocation ethics
- MeSH terms
- Age Factors, Ethics, Medical, Health Priorities, Humans, Morals, Prognosis, Health Care Rationing, Patient Selection, Quality-Adjusted Life Years, Resource Allocation
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