Ethics and Covid-19: Who should get the ventilator when resources are scarce?

  • Ethical decisions regarding the allocation of lifesaving medical resources for patients have been widely debated during the pandemic
  • A new study asked over 5 000 participants from 11 countries whose lives they'd save in such a grim situation
  • The main considerations that influenced their decisions were age and likelihood of surviving

During the Covid-19 pandemic, many difficult decisions have had to be made quickly, including those around the allocation of limited, lifesaving resources.

On the topic of ethics and Covid-19 resource allocation, the World Health Organization (WHO) indicates the following:

“Governments, international agencies and health systems have an obligation to ensure, to the best of their ability, adequate provision of healthcare for all. However, this may not be possible during a pandemic, when health resources are likely to be limited.”

Rationing resources in this context results in the need to make “tragic choices”, the organisation notes, but comments that these choices can be ethically justified according to a principle that prioritises those most in need.

Maximising benefits to society

When over 5 000 people across 11 countries were presented with this moral dilemma of which of two Covid-19 patients should get access to a ventilator that could save their life when medical resources are scarce, the majority of participants felt that the lives of younger patients, as well as those most likely to survive, should be prioritised.

"People seemed to want to maximise total benefits to society by choosing those who would live longest as a result of the treatment, either because of their younger age or because of overall probability of survival," Yunhui Huang, co-author of the study and assistant professor of marketing at The Ohio State University's Fisher College of Business, said in a news release, adding that the responses were “a very utilitarian way of deciding".

The findings were published in the Journal of the Association for Consumer Research.

Dominating characteristics

The researchers, from the US and China, asked study participants to consider 15 possible scenarios, and ultimately choose which of two Covid-19 patients should get access to a ventilator to survive when only one was available. All participants responded online.

The two patients they had to choose between differed on 10 characteristics: age, gender, probability of survival, socioeconomic status, criminal record, the number of people who the patient has infected, family members who have also been infected, the expected number of days that this patient needs to be on the ventilator, the costs paid by public finance, and nationality.

The survey took place between 8 and 18 April this year and, according to the paper, covered about 49% of the world's population and 69% of confirmed Covid-19 cases at the time.

Age and probability of survival explained about 50% of respondents’ decisions, while the other eight characteristics combined explained the other 50%.

"Other than age and probability of survival, the other eight were given considerably lower weight in our sample, and their weights did not differ significantly from one another," said Huang.

Favouring individuals with shared nationality

Despite prioritising those who would bring maximum benefit to society, the researchers also discovered that participants generally preferred prioritising people who shared their own nationality, those who had never committed a crime, and those who were likely to incur lower costs, would need fewer days on the ventilator and had infected fewer people.

Individualistic vs. collectivist cultures

A notable difference was also spotted among people from individualistic (such as the US) versus collectivist cultures (such as China). In the latter case, Chinese respondents had a weaker preference for saving young versus old patients, whereas US respondents attached greater importance on a patient's probability of survival when deciding who got the ventilator.

The researchers said that while their findings are not intended to guide decision-making by doctors or policymakers, it is still important to know how the public feels about these ethical issues.

"Doctors and policymakers need to know how the public thinks about these issues as they communicate about their policies involving these difficult decisions," Huang said.

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