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dc.contributor.author
Krütli, Pius
dc.contributor.author
Rosemann, Thomas
dc.contributor.author
Törnblom, Kjell Y.
dc.contributor.author
Smieszek, Timo
dc.date.accessioned
2018-11-01T12:04:08Z
dc.date.available
2017-06-12T11:49:56Z
dc.date.available
2018-11-01T12:04:08Z
dc.date.issued
2016-07-27
dc.identifier.issn
1932-6203
dc.identifier.other
10.1371/journal.pone.0159086
en_US
dc.identifier.uri
http://hdl.handle.net/20.500.11850/120008
dc.identifier.doi
10.3929/ethz-b-000120008
dc.description.abstract
Background Societies are facing medical resource scarcities, inter alia due to increased life expectancy and limited health budgets and also due to temporal or continuous physical shortages of resources like donor organs. This makes it challenging to meet the medical needs of all. Ethicists provide normative guidance for how to fairly allocate scarce medical resources, but legitimate decisions require additionally information regarding what the general public considers to be fair. The purpose of this study was to explore how lay people, general practitioners, medical students and other health professionals evaluate the fairness of ten allocation principles for scarce medical resources: ‘sickest first’, ‘waiting list’, ‘prognosis’, ‘behaviour’ (i.e., those who engage in risky behaviour should not be prioritized), ‘instrumental value’ (e.g., health care workers should be favoured during epidemics), ‘combination of criteria’ (i.e., a sequence of the ‘youngest first’, ‘prognosis’, and ‘lottery’ principles), ‘reciprocity’ (i.e., those who provided services to the society in the past should be rewarded), ‘youngest first’, ‘lottery’, and ‘monetary contribution’. Methods 1,267 respondents to an online questionnaire were confronted with hypothetical situations of scarcity regarding (i) donor organs, (ii) hospital beds during an epidemic, and (iii) joint replacements. Nine allocation principles were evaluated in terms of fairness for each type of scarcity along 7-point Likert scales. The relationship between demographic factors (gender, age, religiosity, political orientation, and health status) and fairness evaluations was modelled with logistic regression. Results Medical background was a major predictor of fairness evaluations. While general practitioners showed different response patterns for all three allocation situations, the responses by lay people were very similar. Lay people rated ‘sickest first’ and ‘waiting list’ on top of all allocation principles—e.g., for donor organs 83.8% (95% CI: [81.2%–86.2%]) rated ‘sickest first’ as fair (‘fair’ is represented by scale points 5–7), and 69.5% [66.2%–72.4%] rated ‘waiting list’ as fair. The corresponding results for general practitioners: ‘prognosis’ 79.7% [74.2%–84.9%], ‘combination of criteria’ 72.6% [66.4%–78.5%], and ‘sickest first’ 74.5% [68.6%–80.1%); these were the highest-rated allocation principles for donor organs allocation. Interestingly, only 44.3% [37.7%–50.9%] of the general practitioners rated ‘instrumental value’ as fair for the allocation of hospital beds during a flu epidemic. The fairness evaluations by general practitioners obtained for joint replacements: ‘sickest first’ 84.0% [78.8%–88.6%], ‘combination of criteria’ 65.6% [59.2%–71.8%], and ‘prognosis’ 63.7% [57.1%–70.0%]. ‘Lottery’, ‘reciprocity’, ‘instrumental value’, and ‘monetary contribution’ were considered very unfair allocation principles by both groups. Medical students’ ratings were similar to those of general practitioners, and the ratings by other health professionals resembled those of lay people. Conclusions Results are partly at odds with current conclusions proposed by some ethicists. A number of ethicists reject ‘sickest first’ and ‘waiting list’ as morally unjustifiable allocation principles, whereas those allocation principles received the highest fairness endorsements by lay people and to some extent also by health professionals. Decision makers are advised to consider whether or not to give ethicists, health professionals, and the general public an equal voice when attempting to arrive at maximally endorsed allocations of scarce medical resources.
en_US
dc.format
application/pdf
en_US
dc.language.iso
en
en_US
dc.publisher
Public Library of Science
en_US
dc.rights.uri
http://creativecommons.org/licenses/by/4.0/
dc.title
How to Fairly Allocate Scarce Medical Resources: Ethical Argumentation under Scrutiny by Health Professionals and Lay People
en_US
dc.type
Journal Article
dc.rights.license
Creative Commons Attribution 4.0 International
ethz.journal.title
PLoS ONE
ethz.journal.volume
11
en_US
ethz.journal.issue
7
en_US
ethz.journal.abbreviated
PLoS ONE
ethz.pages.start
e0159086
en_US
ethz.size
18 p.
en_US
ethz.version.deposit
publishedVersion
en_US
ethz.identifier.wos
ethz.identifier.nebis
006206116
ethz.publication.place
San Francisco, CA, USA
en_US
ethz.publication.status
published
en_US
ethz.leitzahl
ETH Zürich::00002 - ETH Zürich::00012 - Lehre und Forschung::00007 - Departemente::02350 - Dep. Umweltsystemwissenschaften / Dep. of Environmental Systems Science::02723 - Institut für Umweltentscheidungen / Institute for Environmental Decisions::02351 - TdLab / TdLab
en_US
ethz.leitzahl.certified
ETH Zürich::00002 - ETH Zürich::00012 - Lehre und Forschung::00007 - Departemente::02350 - Dep. Umweltsystemwissenschaften / Dep. of Environmental Systems Science::02723 - Institut für Umweltentscheidungen / Institute for Environmental Decisions::02351 - TdLab / TdLab
ethz.date.deposited
2017-06-12T11:55:59Z
ethz.source
ECIT
ethz.identifier.importid
imp593654ac560ae74097
ethz.ecitpid
pub:182057
ethz.eth
yes
en_US
ethz.availability
Open access
en_US
ethz.rosetta.installDate
2017-07-15T16:03:11Z
ethz.rosetta.lastUpdated
2018-11-01T12:04:12Z
ethz.rosetta.versionExported
true
ethz.COinS
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