Allocating Scarce ICU Resources During Public Health Emergencies: Principles Revisited
DOI:
https://doi.org/10.5281/zenodo.22681218Keywords:
resource allocation, ICU triage, crisis standards of care, disability rights, public health ethicsAbstract
The COVID-19 pandemic forced hospitals to operationalize, for the first time at scale, crisis-standards-of-care frameworks that had previously existed mostly on paper, exposing wide variation in how allocation principles for scarce ICU resources were actually implemented. This review revisits the classical bioethics literature on scarce-resource allocation -- equality, utility, and
priority to the worst off -- and traces how these principles fared once translated into ventilator and ICU-bed
triage protocols during real surges. It examines the sustained disability-rights critique of prognosis-based and quality-adjusted-life-year-adjacent scoring tools, and the parallel debate over whether weighting life-years saved is a defensible refinement of
utilitarian allocation or an invitation to discriminate. We also consider procedural safeguards -- independent triage teams, staged reassessment, and public engagement in drafting criteria -- that emerged from the pandemic experience as arguably as important as
the substantive principle a jurisdiction adopts. We conclude that no single allocation principle has been vindicated by the pandemic experience, but that the crisis-standards documents judged most defensible in retrospect combined workable clinical scoring with
explicit non-discrimination safeguards and a transparent, revisable process.
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