Fair Allocation of Scarce Medical Resources in an Unfair World - Project Summary This proposal will fund the first comprehensive, book-length bioethical analysis of allocating scarce medical resources. Historically, allocation challenges arose at the advent of penicillin, dialysis, and organ transplantation. During the 2000s, allocation frameworks were developed for pandemic influenza countermeasures, including vaccines and ventilators, in the event of a pandemic. More recently, allocation frameworks have been proposed or deployed for the allocation of various COVID-19 countermeasures and treatments, including vaccines, therapies, and intensive care bed space. Such frameworks have also been deployed for the allocation of other resources in limited supply, such as mpox countermeasures, RSV countermeasures, and scarce medicines such as chemotherapeutics and novel GLP-1 inhibitors. The study defines four core ethical goals for allocation: benefiting people and preventing harm; mitigating disadvantage; equal concern; and reciprocity. It then analyzes the ethical, legal, and policy dimensions of metrics, such as lives saved or years of life lost, used by policymakers to assess resource allocation frameworks. Likewise, it analyzes ethical, legal, and policy dimensions of considering various characteristics, such as age, health status, race, and sex, as proxies for expected outcomes. Last, it considers how ethical objectives can be combined into an allocation framework and explains how such a framework can be operationalized and effectively implemented. This work will be of academic value to medical and public health professionals, policymakers, and biomedical researchers (including scholars in bioethics, health law and policy) because medical innovations and medical crises will continue to prompt the need to fairly distribute scarce medical resources. This project will help improve the ethical justification, design, legality, and implementation of such frameworks, enabling them to more effectively mitigate the harms of scarcity while addressing health disadvantage. It will also advance public health by helping public health officials to navigate tradeoffs and avoid ethical and legal pitfalls as they design, operationalize, and implement frameworks for allocating scarce medical resources.
