Department of Ethics
The Lancet, Volume 373, Issue 9661, Pages 423 - 431, 31 January 2009
Principles for allocation of scarce medical interventions
Govind Persad BS a, Alan Wertheimer PhD a, Ezekiel J Emanuel MD a
Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.
UPDATE: Article on end of life care from Alternet -