Douglas B. White, MD, MAS; Bernard Lo, MD; Mitch Katz, MD, MPH
Potential Financial Conflicts of Interest: None disclosed.
White DB, Lo B, Katz M. Ethical Issues and the Allocation of Scarce Resources During a Public Health Emergency. Ann Intern Med. 2009;150:891-892. doi: 10.7326/0003-4819-150-12-200906160-00021
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Published: Ann Intern Med. 2009;150(12):891-892.
We appreciate our colleagues' comments and are heartened to see that our analysis has stimulated further thought among clinicians and policymakers. We agree with Dr. Glass that government has an ethical obligation to carefully plan for foreseeable public health emergencies, such as pandemic influenza. However, because society's resources are limited, it is impossible to fully meet all emergency needs while still allocating adequate resources to competing routine societal needs, such as primary care, education, infrastructure, and defense. Public health emergencies remind us of the inevitable need to balance competing considerations when shaping public policy.
Dr. Hansen-Flaschen uses the 1952 poliomyelitis outbreak in Sweden as a test case for our multiprinciple allocation strategy. He raises the concern that even with a multiprinciple allocation system, clusters of patients may be indistinguishable on the basis of age, prognosis for survival, and life-years saved, requiring a tie-breaking mechanism. This is possible, but not necessarily problematic. If patients are indistinguishable on the basis of allocation principles set forth as morally relevant, then there is no compelling reason to prioritize any one over the others in the group. We advocate that if such a situation occurs, random allocation should be used to break ties.
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