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. (shrink)

Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, and dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, such as tirzepatide, have been found to be effective for treating obesity and diabetes, significantly reducing weight and the risk or predicted risk of adverse cardiovascular events. There is a global shortage of these medications that could last several years and raises questions about how limited supplies should be allocated. We propose a fair-allocation framework that enables evaluation of the ethics of (...) current practices and could guide governments, professional societies, and physicians in allocation decisions. (shrink)

Questions of fair allocation arise regularly throughout our lives, ranging from the trivial to the significant, for governments, private companies, associations, families, and friends. This article discusses the nature of allocative fairness, which is focused on the fair distribution of divisible and indivisible goods. The recent literature on allocative fairness takes John Broome's discussion of fairness as the proportional treatment of claims as its starting point. On this view, a claim is a reason why an individual ought to receive (...) a good. This article discusses the nature of allocative fairness, claims, and goods. The most prominent allocative procedures in the literature are discussed, including equal allocation, equitable allocation, markets, lotteries, and queues. (shrink)

The Rashomon set of equally-good models promises less discriminatory algorithms, reduced outcome homogenization, and fairer decisions through model ensembles or reconciliation. However, we argue from the perspective of allocation multiplicity that these promises may remain unfulfilled. When there are more qualified candidates than resources available, many different allocations of scarce resources can achieve the same utility. This space of equal-utility allocations may not be faithfully reflected by the Rashomon set, as we show in a case study of healthcare allocations. (...) We attribute these unfulfilled promises to several factors: limitations in empirical methods for sampling from the Rashomon set, the standard practice of deterministically selecting individuals with the lowest risk, and structural biases that cause all equally-good models to view some qualified individuals as inherently risky. (shrink)

As the federal government distributed remdesivir to some of the states COVID-19 hit hardest, policymakers scrambled to develop criteria to allocate the drug to their hospitals. Our state, Michigan, was among those states to receive an initial quantity of the drug from the U.S. government. The disparities in burden of disease in Michigan are striking. Detroit has a death rate more than three times the state average. Our recommendation to the state was that it should prioritize the communities that bear (...) a disproportionate burden of suffering in the allocation of the new potential treatment. This recommendation is justified not only for new drugs with uncertain effects, but also for drugs of certain benefit or vaccines. For states with significant health disparities, such as Michigan, this allocation priority may help to repair them. In fact, any other allocation strategy may make them worse. (shrink)

In our reply to critiques of our GLP-1 receptor agonist allocation framework, we explain that using potential years of life lost (PYLL) as a metric addresses racial health disparities without explicitly allocating resources based on race. This approach is "racism-conscious" and has legal and ethical challenges over race-based approaches. Meanwhile, though acknowledging the importance of cardiovascular risk assessment, we maintain in response to other interlocutors that focusing solely on immediate risk would ignore the broader goal of mitigating disadvantage. We (...) emphasize that our framework balances multiple ethical objectives beyond just maximizing medical benefits. (shrink)

This paper introduces the Fiat-Credit Allocation Theorem (FCAT), developed by Aaron Black. Since the collapse of Bretton Woods in the early 1970s, advanced economies have operated under a distinct monetary and financial regime characterized by pure fiat currencies, elastic bank credit creation, and widespread securitization of cash flows. The Fiat–Credit Allocation Theorem (FCAT) is a structural law governing credit allocation in this post-1971 era. In a fiat system with low-friction securitization, credit endogenously expands into securitizable assets whenever (...) their perceived risk-adjusted expected returns exceed the system-wide required return on risky capital (r ˉ), and contracts when returns fall below this hurdle rate. In equilibrium, risk-adjusted returns on funded securitized cash flows converge to r ˉ, creating a yield-arbitrage mechanism that drives sustained asset-price inflation, financialization, rentier dominance, and recurrent credit-driven booms and busts. The theorem formalizes this process in a minimal continuous-time framework, proves convergence under mild assumptions, and interprets key post-Bretton Woods phenomena—decoupled capital returns from wage growth, persistent r>gdynamics, and leverage cycles—as equilibrium outcomes rather than anomalies. Empirical proxies, including yield convergence across securitized asset classes post-1971, support the model's predictions. FCAT provides a unified micro-founded explanation for the regime shift from production-constrained credit to yield-chasing credit, with implications for inequality, affordability in essential sectors, and the limits of supply-side reforms. (shrink)

Hundreds of millions of rare biospecimens are stored in laboratories and biobanks around the world. Often, the researchers who possess these specimens do not plan to use them, while other researchers limit the scope of their work because they cannot acquire biospecimens that meet their needs. This situation raises an important and underexplored question: how should scientists allocate biospecimens that they do not intend to use? We argue that allocators should aim to maximise the social value of the research enterprise (...) when allocating scarce biospecimens. We provide an ethical framework for assessing the social value of proposed research projects and describe how the framework could be implemented. (shrink)

The U.S. FDA has issued emergency use authorizations for monoclonal antibodies for non-hospitalized patients with mild or moderate COVID-19 disease and for individuals exposed to COVID-19 as post-exposure prophylaxis. One EUA for an oral antiviral drug, molnupiravir, has also been recommended by FDA’s Antimicrobial Drugs Advisory Committee, and others appear likely in the near future. Due to increased demand because of the Delta variant, the federal government resumed control over the supply and asked states to ration doses. As future variants (...) with increased infectivity and/or severity emerge, further rationing may be required. We identify relevant ethical principles and priority groups for access to therapies based on an integrated approach to population health and medical factors. Using priority categories to allocate scarce therapies effectively operationalizes important ethical values. This strategy is preferable to the current approach of categorical rules based on vaccination, immunocompromise status, or older age, or the ad hoc consideration of clinical risk factors. (shrink)

Action must be taken to combat climate change. Yet, how the costs of climate action should be allocated among states remains a question. One popular answer—the polluter-pays principle (PPP)—stipulates that those responsible for causing the problem should pay to address it. While intuitively plausible, the PPP has been subjected to withering criticism in recent years. It is timely, following the Paris Agreement, to develop a new version: one that does not focus on historical production-based emissions but rather allocates climate burdens (...) in proportion to each state’s annual consumption-based emissions. This change in carbon accounting results in a fairer and more environmentally effective principle for distributing climate duties. (shrink)

Rapidly expanding data centers along with networks create a fundamental problem regarding resource allocation efficiency. Standard resource management systems prove unable to adapt dynamically to varying workloads so bandwidth allocation and computing utilization stays inefficient. Developers use recent advancements in artificial intelligence technology to build automatic optimization algorithms that instantly adjust resource distributions. Through the integration of machine learning with deep reinforcement learning systems organizations obtain predictive power to prepare resource distribution ahead of time without endangering operational efficiency. (...) According to Gandhi et al. (2012), both tested methods achieve enhanced energy efficiency while preventing delivery slowness. The study explores how AI addresses data facility network resource optimization by examining key techniques and discovering current trends and future development directions. (shrink)

This working paper is a feedback submission to Singapore’s Infocomm Media Development Authority on the Model AI Governance Framework for Agentic AI (version 1.5). It argues that the framework is operationally strong, but that its aspiration to secure ‘meaningful accountability’ requires three further refinements. First, the paper distinguishes allocation from answerability: assigning a named human, team, or role does not by itself ensure that anyone can reconstruct, justify, and bear responsibility for a specific agentic-AI action. Secondly, it argues that (...) composition is a distinct source of risk in multi-agent systems, because a duty may be satisfied at every individual node yet fail at the level of the composed system. Thirdly, it argues that binding constraints on high-stakes or irreversible agent actions must sit at an objective layer outside the agent’s generative reach, rather than merely inside prompts, behavioural instructions, or model-context safeguards. The paper also clarifies the distinction between autonomy and agency, recommending that responsibility-language be reserved for humans and institutions, while capability-language be used for artificial agents. The submission therefore develops a governance account in which traceability, allocation, oversight, and identity management are necessary but insufficient unless linked to institutional answerability and structurally enforceable constraints. (shrink)

In response to the COVID‐19 pandemic philosophers and governments have proposed scarce resource allocation guidelines. Their purpose is to advise healthcare professionals on how to ethically allocate scarce medical resources. One challenging feature of the pandemic has been the large numbers of patients needing mechanical ventilatory support. Guidelines have paradigmatically focused on the question of what doctors should do if they have fewer ventilators than patients who need respiratory support: which patient should get the ventilator? There is, however, an (...) important higher level allocation problem. Namely, how are we to ethically distribute newly obtained ventilators across hospitals: which hospital should get the ventilator(s)? In this paper, we identify a set of principles for allocating newly obtained ventilators across hospitals. We focus particularly on low and middle income countries, who frequently have limited pre‐existing intensive care capacity, and have needed to source additional ventilators. We first provide some background. Second, we argue that the main population healthcare aim during the COVID‐19 pandemic should be to save the most lives. Next, we assess a series of potential heuristics or principles that could be used to guide allocation: allocation to the most densely populated cities, random allocation, allocation based on the ratio of patients to ICU personnel, prioritisation in terms of intrahospital mortality, prioritisation of younger populations, and prioritisation in terms of population mortality. We conclude by providing a plausible ranking of the principles, while noting a number of epistemological challenges, in terms of how they best further the aim of increasing the probability of saving the most lives. (shrink)

Although a safe, effective, and licensed coronavirus vaccine does not yet exist, there is already controversy over how it ought to be allocated. Justice is clearly at stake, but it is unclear what justice requires in the international distribution of a scarce vaccine during a pandemic. Many are condemning ‘vaccine nationalism’ as an obstacle to equitable global distribution. We argue that limited national partiality in allocating vaccines will be a component of justice rather than an obstacle to it. For there (...) are role-based and community-embedded responsibilities to take care of one’s own, which constitute legitimate moral reasons for some identity-related prioritisation. Furthermore, a good form of vaccine nationalism prioritises one’s own without denying or ignoring duties derived from a principle of equal worth, according to which all persons, regardless of citizenship or identity, equally deserve vaccine-induced protection from COVID-19. Rather than dismissing nationalism as a tragic obstacle, it is necessary to acknowledge that a limited form of it is valuable and expresses moral commitments. Only then can one understand our world of competing obligations, a world where cosmopolitan duties of benevolence sometimes conflict with special obligations of community membership. Once these competing obligations are recognised as such, we can begin the work of designing sound ethical frameworks for achieving justice in the global distribution of a coronavirus vaccine and developing practical strategies for avoiding, mitigating or resolving conflicts of duty. (shrink)

Reserve systems are a tool to allocate scarce resources when stakeholders do not have a single objective. This paper introduces some basic concepts about reserve systems for pandemic medical resource allocation. At the onset of the Covid-19 pandemic, we proposed that reserve systems can help practitioners arrive at compromises between competing stakeholders. More than a dozen states and local jurisdictions adopted reserve systems in initial phases of vaccine distribution. We highlight several design issues arising in some of these implementations. (...) We also offer suggestions about ways practitioners can take advantage of the flexibility offered by reserve systems. (shrink)

One widely used method for allocating health care resources involves the use of cost-effectiveness analysis (CEA) to rank treatments in terms of quality-adjusted life-years (QALYs) gained. CEA has been criticized for discriminating against people with disabilities by valuing their lives less than those of non-disabled people. Avoiding discrimination seems to lead to the ’QALY trap’: we cannot value saving lives equally and still value raising quality of life. This paper reviews existing responses to the QALY trap and argues that all (...) are problematic. Instead, we argue that adopting a moderate form of prioritarianism avoids the QALY trap and disability discrimination. (shrink)

Countermeasures for mpox (formerly known as monkeypox), primarily vaccines, have been in limited supply in many countries during outbreaks. Equitable allocation of scarce resources during public health emergencies is a complex challenge. Identifying the objectives and core values for the allocation of mpox countermeasures, using those values to provide guidance for priority groups and prioritisation tiers, and optimising allocation implementation are important. The fundamental values for the allocation of mpox countermeasures are: preventing death and illness; reducing (...) the association between death or illness and unjust disparities; prioritising those who prevent harm or mitigate disparities; recognising contributions to combating an outbreak; and treating similar individuals similarly. Ethically and equitably marshalling available countermeasures requires articulating these fundamental objectives, identifying priority tiers, and recognising trade-offs between prioritising the people at the highest risk of infection and the people at the highest risk of harm if infected. These five values can provide guidance on preferable priority categories for a more ethically sound response and suggest methods for optimising allocation of countermeasures for mpox and other diseases for which countermeasures are in short supply. Properly marshalling available countermeasures will be crucial for future effective and equitable national responses to outbreaks. (shrink)

Contrary to traditional deterministic notions of algorithmic fairness, this paper argues that fairly allocating scarce resources using machine learning often requires randomness. We address why, when, and how to randomize by proposing stochastic procedures that more adequately account for all of the claims that individuals have to allocations of social goods or opportunities.

This correspondence from The Lancet addresses critiques and responses regarding ethical frameworks for allocating scarce medical resources, particularly during the COVID-19 pandemic. Emanuel and Persad defend their position that scarcity is a reality requiring principled allocation decisions, responding to Smith's assertion that viewing scarcity as inevitable is "problematic and irresponsible." They argue that without effective ethical guidance, well-resourced individuals will monopolize scarce resources while others debate ending scarcity theoretically. The authors emphasize five fundamental values for fair allocation. They (...) critique "first come, first served" approaches that favor privileged populations with internet access and mobility. The correspondence also addresses concerns about public engagement, sustainability principles, and the distinction between resource allocation and fair compensation for essential workers. The authors conclude that ethical values are only one piece of the allocation puzzle and that fair allocation also requires robust institutional infrastructure to ensure equitable distribution of scarce medical resources. (shrink)

This paper presents the Common Capital Allocation System (CCAS), a post-capitalist design that rejects both private ownership of large-scale productive capital and centralised state planning. The core diagnosis is that capitalism fails structurally by rewarding externalisation of costs and passive extraction over productive contribution. The alternative rests on five principles: no passive earning, public capital ownership, temporary performance-conditional control, performance-based compensation only, and a universal safety net. -/- Capital is allocated through crowdfunding for consumer-facing projects and expert-weighted prediction markets (...) for complex investments. Private wealth is limited to capped, non-inheritable government bonds generating no passive income. The political layer combines futarchy with liquid democracy, unifying economic and political governance under identical allocation infrastructure. Transition is conceived as competitive displacement rather than expropriation. The paper identifies open empirical questions — motivation without ownership, prediction market calibration, property boundaries — while arguing these are practical rather than logical challenges. (shrink)

The COVID-19 pandemic has helped to clarify the fair and equitable allocation of scarce medical resources, both within and among countries. The ethical allocation of such resources entails a three-step process: (1) elucidating the fundamental ethical values for allocation, (2) using these values to delineate priority tiers for scarce resources, and (3) implementing the prioritisation to faithfully realise the fundamental values. Myriad reports and assessments have elucidated five core substantive values for ethical allocation: maximising benefits and (...) minimising harms, mitigating unfair disadvantage, equal moral concern, reciprocity, and instrumental value. These values are universal. None of the values are sufficient alone, and their relative weight and application will vary by context. In addition, there are procedural principles such as transparency, engagement, and evidence-responsiveness. Prioritising instrumental value and minimising harms during the COVID-19 pandemic led to widespread agreement on priority tiers to include health-care workers, first responders, people living in congregate housing, and people with an increased risk of death, such as older adults and individuals with medical conditions. However, the pandemic also revealed problems with the implementation of these values and priority tiers, such as allocation on the basis of population rather than COVID-19 burden, and passive allocation that exacerbated disparities by requiring recipients to spend time booking and travelling to appointments. This ethical framework should be the starting point for the allocation of scarce medical resources in future pandemics and other public health conditions. For instance, allocation of the new malaria vaccine among sub-Saharan African countries should be based not on reciprocity to countries that participated in research, but on maximally reducing serious illness and deaths, especially among infants and children. (shrink)

While there has been significant discussion in the health sciences and ethics literatures about problems associated with publication practices (e.g., ghost- and gift-authorship, conflicts of interest), there has been relatively little practical guidance developed to help researchers determine how they should fairly allocate credit for multi-authored publications. Fair allocation of credit requires that participating authors be acknowledged for their contribution and responsibilities, but it is not obvious what contributions should warrant authorship, nor who should be responsible for the quality (...) and content of the scientific research findings presented in a publication. In this paper, we review arguments presented in the ethics and health science literatures, and the policies or guidelines proposed by learned societies and journals, in order to explore the link between author contribution and responsibility in multi-author multidisciplinary health science publications. We then critically examine the various procedures used in the field to help researchers fairly allocate authorship. (shrink)

Some Comments on de Melo-Martin and Harris.

The thesis that the state withers away addresses the class-domination form of political authority and leaves open what governance a complex society continues to require once the distribution question has been answered. This paper takes up that remainder. It sets out a functional typology of governance, distinguishing the allocative, coordinative, interpretive and generative functions, and argues that these accumulate as a society grows more complex. It then gives an epistemic account of authority. Where the cost of verifying a claim exceeds (...) what any individual can bear, the question of whom to believe becomes an allocation of epistemic attention, and what an established authority supplies is a reduction of the verification cost borne across a community, an operation named here interpretive compression. Institutions and commons are accordingly complementary: commons expand the space of interpretations under consideration and institutions compress it, and generation halts at either limit. The account carries an evident hazard, since an explanation of authority by verification cost stands one step from a warrant for whichever authority happens to compress, and the paper answers it with a criterion: a compression remains contestable while the path of reopening it stays available to those subject to it, and it becomes appropriation once that path closes. The disappearance thesis is then restated in these terms. What the thesis reaches is allocative domination; relational regulation is left standing, since finite rationality, verification cost and interpretive conflict persist under any distribution of resources. A further condition is entered, concerning the position from which the bindingness of a norm is underwritten, which the disappearance of a state leaves standing. A concluding section argues that this persistence claim should be entered as an observation with specified mechanisms, and declines to state it as a conservation principle. (shrink)

In this paper, we address the moral justification problem concerning the use of age as a criterion for the allocation of scarce life-saving medical resources. We present and discuss four justifications that stand out in philosophical literature: efficiency, sufficiency, egalitarian, and prioritarian. We aim to demonstrate that all these justifications are unsatisfactory since they entail counterintuitive implications in cases involving fetuses and newborns. We then suggest another justification for the relevance of age based on the Time-Relative Interest Account of (...) the harm of death. Finally, we evaluate an objection that could limit the scope of the defended justification, leading us to draw a distinction between justification of harm and strict justification of harm. (shrink)

When allocating scarce healthcare resources, the expected benefits of alternative allocations matter. But, there are different kinds of benefits. Some are direct benefits to the recipient of the resource such as the health improvements of receiving treatment. Others are indirect benefits to third parties such as the economic gains from having a healthier workforce. This article considers whether only the direct benefits of alternative healthcare resource allocations are relevant to allocation decisions, or whether indirect benefits are relevant too. First, (...) we distinguish different conceptions of direct and indirect benefits and argue that only a recipient conception could be morally relevant. We analyze four arguments for thinking that indirect benefits should not count and argue that none is successful in showing that the indirectness of a benefit is a good reason not to count it. We conclude that direct and indirect benefits should be evaluated in the same way. (shrink)

In the first wave of the COVID-19 pandemic, healthcare workers in some countries were forced to make distressing triaging decisions about which individual patients should receive potentially life-saving treatment. Much of the ethical discussion prompted by the pandemic has concerned which moral principles should ground our response to these individual triage questions. In this paper we aim to broaden the scope of this discussion by considering the ethics of broader structural allocation decisions raised by the COVID-19 pandemic. More specifically, (...) we consider how nations ought to distribute a scarce life-saving resource across healthcare regions in a public health emergency, particularly in view of regional differences in projected need and existing capacity. We call this the regional triage question. Using the case study of ventilators in the COVID-19 pandemic, we show how the moral frameworks that we might adopt in response to individual triage decisions do not translate straightforwardly to this regional-level triage question. Having outlined what we take to be a plausible egalitarian approach to the regional triage question, we go on to propose a novel way of operationalising the ‘save the most lives’ principle in this context. We claim that the latter principle ought to take some precedence in the regional triage question, but also note important limitations to the extent of the influence that it should have in regional allocation decisions. (shrink)

Aiming at the allocation of scarce medical resources, Immanuel and other scholars have put forward a set of influential ethical values and guiding principles. It assigns the priority of resource allocation to those whose lives can be saved and maximized, those who can bring the greatest instrumental value, and those who are the worse off. For other members of society, random selection under the same conditions is adopted. Following the Rawlsian "lexical order, lexicographical" rule, this priority arrangement requires (...) that the "utilitarian principle" should be placed before the "equality principle", and the "instrumental difference principle", the "integrity difference principle" and the "fair opportunity principle" in turn acts on specific distribution agents. Although the framework and its priority rules have obvious drawbacks when faced with Medical Resources Squeeze and other dilemmas, with the help of an understanding of its internal structure, it can effectively respond to the four core issues in the allocation of scarce medical resources. (shrink)

This paper presents a robust stage-based system for equitable resource allocation, using water as a proxy for all essential resources and Bitcoin (B1) as Earth’s primary currency. The system ensures fairness by resetting Bitcoin’s value to 1 water unit post-hack, progressively eliminating malicious actors via an infinite Bitcoin trap (B2), and updating block hashes with new timestamps to counter blockchain hacks without re-mining. A key principle is that the Bitcoin genesis block hash, created by Satoshi Nakamoto (000000000019d6689c085ae165831e934ff763ae46a2a6c172b3f1b60a8ce26f), is the (...) only constant hash across all Bitcoin-based systems, holding intrinsic value greater than all hackers’ wealth combined. This hash anchors trust, immutability, and fairness, ensuring Satoshi symbolically retains 1 BTC as the system’s cornerstone. Simulations confirm the system supports non-malicious individuals, eliminates hackers, and upholds the genesis hash’s primacy, aligning with economic principles (Smith, 1776; Keynes, 1936) and systems theory (von Bertalanffy, 1956). (shrink)

This article examines multi-agent architectures in institutional asset allocation—exemplified by ‘self-driving portfolio’ systems—through the lens of evaluative structure. While these systems distribute forecasting and allocation across specialised agents, selection remains governed by a fixed Investment Policy Statement (IPS). The central claim is that such architectures expand search over the portfolio space without addressing the specification or revision of the objective function. The analysis formalises a distinction between optimisation and evaluation. In current systems, the evaluative structure remains external, so (...) errors and disagreement are processed relative to a fixed objective rather than as evidence of its mis-specification. Recasting multi-agent systems as ensemble optimisers, the article shows that model diversity does not imply outcome independence under shared evaluative criteria. A stylised simulation isolates the consequences of shared evaluation. Increasing similarity produces greater portfolio overlap, higher concentration, and stronger drawdown correlation under stress, with clustered adaptation dynamics. The article defines the objective problem, distinguishes parametric adaptation from evaluative revision, introduces evaluative crowding, and proposes Objective-Layer AI as a minimal extension in which objectives become operational variables within the system. The frontier lies in designing and governing the objective layer itself. (shrink)

Non‐governmental aid programs are an important source of health care for many people in the developing world. Despite the central role non‐governmental organizations play in the delivery of these vital services, for the most part they either lack formal systems of accountability to their recipients altogether, or have only very weak requirements in this regard. This is because most NGOs are both self‐mandating and self‐regulating. What is needed in terms of accountability is some means by which all the relevant stakeholders (...) can have their interests represented and considered. An ideally accountable decision‐making process for NGOs should identify acceptable justifications and rule out unacceptable ones. Thus, the point of this paper is to evaluate three prominent types of justification given for decisions taken at the Dutch headquarters of Médecins sans Frontières. They are: population health justifications, mandate‐based justifications and advocacy‐based justifications. The central question at issue is whether these justifications are sufficiently robust to answer the concerns and objections that various stakeholders may have. I am particularly concerned with the legitimacy these justifications have in the eyes of project beneficiaries. I argue that special responsibilities to certain communities can arise out of long‐term engagement with them, but that this type of priority needs to be constrained such that it does not exclude other potential beneficiaries to an undesirable extent. Finally, I suggest several new institutional mechanisms that would enhance the overall equity of decisions and so would ultimately contribute to the legitimacy of the organization as a whole. (shrink)

The structural scarcity of healthcare resources has deeply challenged their fair distribution, prompting the need for allocation criteria. Long under the spotlight of the bioethical debate with an extraordinary peak during the recent COVID-19 pandemic, micro-allocation of healthcare has been extensively discussed in the literature with regard to issues of substantive and formal justice. This paper addresses a relatively underdiscussed question within the field of formal justice: who should define micro-allocation criteria in healthcare? To explore this issue, (...) we first establish formal requirements that must be met for allocation criteria to be considered fair and legitimate. Then, we introduce three possible answers to the research question: the attending physician, the team of physicians, and the team of experts. We discuss and then reject all of them, arguing that the task of defining allocation criteria should be assigned to a political representative, supported by a cross-disciplinary team of experts. This proposal is based on the need to take democracy seriously as a tool for making substantive allocative decisions in light of the inevitable disagreement on such matters within a community. To support this claim, we present two key arguments—the democracy argument and the consistency argument. We also pre-emptively respond to two significant critiques: the too-specificity of the decision critique and the catastrophic outcomes critique. In conclusion, we argue that our proposal offers the fairest and most legitimate decision-making process for healthcare micro-allocation. (shrink)

One hundred and ninety participants (95 undergraduates and 95 employees) responded to a factorial survey in which a number of case-based organizational allocation tasks were described. Participants were asked to imagine themselves as employees in fictitious organizations and chose among three allocations of employee development schemes invested by the manager in different work groups. The allocations regarded how such investments should be allocated between two parties. Participants chose twice, once picking the fairest and once the best allocation. One (...) between-subjects factor varied whether the parties represented social (i.e., choosing among allocations between two different work groups) or temporal comparisons (i.e., choosing among allocations between the present and the following year). Another between-subjects factor varied whether participants’ in-group was represented by the parties or not. One allocation maximized the outcome to one party, another maximized the joint outcome received by both parties, and a third provided both parties with equal but lower outcomes. It was predicted that equality, although always deficient to both parties, would be the preferred allocation when parties represented social comparisons and when choices were based on fairness. When parties represented temporal comparisons, and when choices were based on preference, maximizing the joint outcome was hypothesized to be the preferred allocation. Results supported these hypotheses. Against what was predicted, whether the in-group was represented by the parties or not did not moderate the results, indicating that participants’ allocation preferences were not affected by self-interest. The main message is that people make sensible distinctions between what they prefer and what they regard as fair. The results were the same for participating students who imagined themselves as being employees and participants who were true employees, suggesting that no serious threats to external validity are committed when university students are used as participants. (shrink)

When hospitals face surges of patients with COVID-19, fair allocation of scarce medical resources remains a challenge. Scarcity has at times encompassed not only hospital and intensive care unit beds—often reflecting staffing shortages—but also therapies and intensive treatments. Safe, highly effective COVID-19 vaccines have been free and widely available since mid-2021, yet many Americans remain unvaccinated by choice. Should their decision to forgo vaccination be considered when allocating scarce resources? Some have suggested it should, while others disagree. We offer (...) a framework for evaluating when it is ethical and briefly discuss its legality in American law. (shrink)

As human-AI collaboration becomes increasingly complex and AI autonomy continues to expand, traditional binary responsibility allocation models have shown fundamental failures. This paper proposes a "third way" that acknowledges the ontological irreducibility of the responsibility gap while providing a structured responsibility allocation framework—the Responsibility Gradient Model—based on the Composite Cost Index (CCI). The model's core contributions include: (1) opening a theoretical space between "bridging" and "proving" approaches; (2) shifting the determining variable of the gradient from "agency" to "existential (...) cost"; (3) constructing a gradient framework with four governance levels and six responsibility allocation modes. (shrink)

With vaccination against COVID-19 well underway, providers in the United States (U.S.) found that vials of the Pfizer/BioNTech and Moderna vaccines contained more doses than listed. Because of limited vaccine shelf life, vaccine-providing institutions have thrown extra doses away or quickly distributed them using ad-hoc allocation schemes (drawing names from waiting lists or administering doses to whomever happened to be nearby). This Viewpoint argues that these practices are ethically inadequate and proposes an alternate distribution scheme based on the system (...) in the U.S. to allocate donated organs. The proposal allows for the allocation of unanticipated doses in a way that maximizes societal benefits, is fair, and considerate of the sensitive time constraints for preserving vaccine effectiveness. (shrink)

Queuing to receive a desired good is a method of allocation deeply entrenched into our lives – be it waiting for housing, to become a member of certain clubs, or to receive promotion. We therefore often take it for granted that, other things being equal, those who have been waiting the longest enjoy priority. But should this always be so? In this comment, we respond to the suggestion of replacing waiting lists in medical settings with a last-come-first-served approach. Drawing (...) parallels with the allocation of donor organs, we argue that both medical utility and equity would be diminished by policies that simply prioritise the most recent referral. (shrink)

This essay develops a dynamic refinement of the realignment mechanism within the Dual-Layered Reality (DLR) framework. The standard formulation in the main manuscript adopts, for expository convenience, a superset framing in which the total informational endowment available across an individual's branching-tree is committed at root realignment. The refinement developed here is the operational implementation of that same superset at the node level: each node's informational allocation is committed at the moment of agent-realignment, with the superset's total capacity equal to (...) the sum of node-level allocations across all realigned life-paths for the individual. This operational implementation yields two structural gains. First, it maximizes the efficiency of finite informational resources: reservoir capacity is drawn only when an agent realigns with a node, so potential nodes that never receive realignment never consume reservoir capacity at all. Second, it maximizes the structural grounding of agency: choice, free will, and causality from the agent's perspective acquire a precise architectural locus through the dynamics of realignment and the cascading consequences of non-realignment at branching-events. The architecture rests on six interlocking commitments — pre-encoded determinism at the lattice level, agent realignment as the locus of genuine causality, path-bound agent identity within branching-trees, no-alteration of actualized nodes as the load-bearing structural principle, node-level informational allocation as efficient use of finite resources, and dynamic erasure of unrealigned potential from the agent's availability set Ai (not from the lattice of L1 itself). It is developed first for individual life-paths, where the relevant concepts have their natural domain, and then generalized to all nodes in the lattice, with phenomenological agency distinguished from structural agency. The result is an account of compatibilist free will in which agency is not the libertarian capacity to do otherwise, but the structural event by which a path-specific agent in superposition becomes actualized through realignment, sustaining the branching-tree's continuation against the structural pull toward collapse. (shrink)

The importance of education in boosting the manpower of an economy cannot be overemphasized. This critical sector has been bastardized, relegated and put in a dust bin position through paltry figures usually allocated to it by the Federal Government of Nigeria. This paper presents a holistic trend of budgetary activities in Nigeria with a particular focus on the allocation to the Education sector using times series approach from 2009-2018. Two research questions were answered using secondary data gathered from the (...) Central Bank of Nigeria's Statistical Bulletin, 2018. Collected data were analyzed using descriptive statistics, while the results of the analysis showed that, the total allocation to the education sector from 2009 – 2018 is N4,038,115,000,000. The results further revealed a difference of N 10,311,805,000,000 between UNESCO benchmark of 26% and the actual allocation to the education sector for the same time period. It was concluded that the total allocation made to the education sector within the time period of 2009-2018 is generally low, and below the UNESCO benchmark. Based on the findings, it was recommended amongst others that the Federal Government of Nigeria should adequately fund the educational sector by allocating at least 26% of her budget to the education sector as prescribed by UNESCO. (shrink)

This article examines the ethical considerations surrounding the incorporation of vaccination status into scarce medical resource allocation frameworks during infectious disease outbreaks. The authors analyze four distinct ethical objectives that guide allocation decisions: benefiting people and preventing harm, mitigating disadvantage, showing equal concern, and satisfying claims of reciprocity. They argue that vaccination status can legitimately inform allocation decisions under certain circumstances, challenging claims that such considerations are categorically inappropriate or impractical. Forward-looking rationales generally support prioritizing unvaccinated individuals (...) for vaccines and antivirals based on expected benefit, while backward-looking reciprocity arguments may favor vaccinated individuals for certain scarce resources. The authors contend that vaccination status represents a voluntary decision rather than an immutable characteristic, distinguishing it from discriminatory practices. They conclude that context-specific empirical analysis is necessary to determine when vaccination status should influence allocation policies, rejecting both blanket prohibitions and universal applications of vaccination-sensitive allocation criteria. (shrink)

Cognitive systems must process environmental signals, internal representations, and decision requirements while operating under strict structural limits. This paper interprets cognitive load within the Paton System framework as the distribution of processing demand across the admissible capacity of a cognitive architecture. Rather than treating load purely as a psychological variable, the Paton System models it as a structural allocation problem governed by admissibility boundaries. Within this framework, cognition maintains coherence between perception, evaluation, and action when processing demand remains within (...) admissible structural limits. Cognitive systems operate under constraints including memory capacity, attentional bandwidth, processing speed, and energetic limitations. These constraints define the structural envelope within which cognition can operate. Cognitive load distribution therefore refers to the allocation of processing capacity across concurrent cognitive tasks. Attention, working memory, and executive control mechanisms regulate this distribution to ensure that no subsystem exceeds admissible limits. When cognitive demand exceeds these limits, instability emerges in the form of overload, degraded decision-making, perceptual filtering failure, or behavioural error. Under extreme informational strain, cognitive systems compress activity toward a minimal viable configuration corresponding to the Lowest Admissible Configuration (LCD), preserving only identity-maintaining processes. By interpreting cognitive load as an admissibility-regulated structural allocation problem, the Paton System clarifies how cognitive systems maintain stability and coherence under conditions of informational complexity. (shrink)

The coronavirus disease 2019 (COVID-19) pandemic has motivated medical ethicists and several task forces to revisit or issue new guidelines on allocating scarce medical resources. Such guidelines are relevant for the allocation of scarce therapeutics and vaccines and for allocation of ICU beds, ventilators, and other life-sustaining treatments or potentially scarce interventions. Principles underlying these guidelines, like saving the most lives, mitigating disparities, reciprocity to those who assume additional risk (eg, essential workers and clinical trial participants), and equal (...) access may compete with one another. We propose the use of a “categorized priority system” (also known as a “reserve system”) as an improvement over existing allocation methods, particularly because it may be able to achieve disparity mitigation better than other methods. (shrink)

The concept of distributed moral responsibility (DMR) has a long history. When it is understood as being entirely reducible to the sum of (some) human, individual and already morally loaded actions, then the allocation of DMR, and hence of praise and reward or blame and punishment, may be pragmatically difficult, but not conceptually problematic. However, in distributed environments, it is increasingly possible that a network of agents, some human, some artificial (e.g. a program) and some hybrid (e.g. a group (...) of people working as a team thanks to a software platform), may cause distributed moral actions (DMAs). These are morally good or evil (i.e. morally loaded) actions caused by local interactions that are in themselves neither good nor evil (morally neutral). In this article, I analyse DMRs that are due to DMAs, and argue in favour of the allocation, by default and overridably, of full moral responsibility (faultless responsibility) to all the nodes/agents in the network causally relevant for bringing about the DMA in question, independently of intentionality. The mechanism proposed is inspired by, and adapts, three concepts: back propagation from network theory, strict liability from jurisprudence and common knowledge from epistemic logic. (shrink)

Should priority in the allocation of organs be given to those who have previously donated or declared their willingness to do so? This article examines the Israeli priority rule in light of two prominent critiques of priority rules, pertaining to failure to reciprocate and unfairness. The scope and content of these critiques are interpreted from the perspective of equality of opportunity. Because the Israeli priority rule may be reasonably criticized for unfairness and failing to reward certain behaviors, the article (...) develops an adjusted priority rule, which removes and adjust the elements in the Israeli priority rule deemed problematic. However, such a priority rule is complex to the extent that it may fail to increase donation rates and furthermore introduce new concerns of fairness, as the better off may be better able to navigate the complex adjusted priority rule. (shrink)

In a previous work, Aesthetics and Ethics as Cognitive Resonance, I argued that ethical evaluation does not rest on natural norms or prescriptive principles but emerges as a form of cognitive resonance between possible configurations of action and the cognitive–affective organization of the agents involved. The present article extends that framework to the political domain. The central claim is that many contemporary crises of representation and of the traditional left–right distinction stem from the persistent use of normative categories to describe (...) problems that are, in the first instance, allocative in nature. The article interprets merit and need not as opposing moral principles but as the extremes of a continuous allocative gradient along which concrete political decisions are positioned. This gradient is neither fixed nor ideological but dynamic, shifting in response to changing socio-economic, technological, and demographic conditions. In the absence of a natural norm from which criteria of justice could be deduced, politics is therefore understood here as the practice of contingent positioning along this gradient, oriented toward maintaining conditions of coordination and political resonance rather than toward the application of absolute values. The analysis is deliberately situated within the context of Western market economies, characterized by a long tradition of individualism, secularization, and discursive legitimation of political decisions, and does not aim to provide a general theory of politics applicable across all institutional and cultural contexts. Within this framework, the proposed perspective helps reinterpret both the crisis of traditional political categories and the contemporary paradox whereby materially need-oriented policies increasingly emerge from actors historically associated with merit, while forces traditionally linked to redistribution remain bound to a normative grammar misaligned with present systemic conditions. The aim of the paper is not prescriptive but clarificatory: to offer a conceptual description of politics compatible with systemic complexity, persistent conflict, and the absence of natural moral foundations. (shrink)

This chapter examines how social- scientific research on public preferences bears on the ethical question of how those resources should in fact be allocated, and explain how social-scientific researchers might find an understanding of work in ethics useful as they design mechanisms for data collection and analysis. I proceed by first distinguishing the methodologies of social science and ethics. I then provide an overview of different approaches to the ethics of allocating scarce medical interventions, including an approach—the complete lives system—which (...) I have previously defended, and a brief recap of social-scientific research on the allocation of scarce medical resources. Following these overviews, I examine different ways in which public preferences could matter to the ethics of allocation. Last, I suggest some ways in which social scientists could learn from ethics as they conduct research into public preferences regarding the allocation of scarce medical resources. (shrink)

After the digital revolution, quality journalism is more necessary than ever. And yet, journalism is undergoing an unprecedented economic crisis precisely because the digital revolution led its advertisement-based funding system to collapse. How can we save journalism as a key institution for upholding the quality of democratic deliberation? Most approaches to this question focus either on media literacy campaigns, restricting the dissemination of disinformation, or fostering public media. This article explores another, largely neglected approach: the civic strategy in media policy, (...) which consists of distributing public funds among private news media through democratic allocation mechanisms. Civic media policies promise to create a more democratic media system, enhance media pluralism, and, crucially, secure robust funding for quality journalism. To examine how they might do so, I assess the four main proposals within this civic paradigm: Cagé’s proposal to create ‘nonprofit media organizations’, Latham’s ‘voter-funded media’ system, Ackerman’s ‘internet news voucher’, and McChesney and Nichols’ ‘citizenship news voucher’. Drawing on a critical examination of these proposals, I extract some lessons for designing more effective civic media policies in the future. (shrink)

Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino (...) and Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

When life-saving medical resources are scarce and not everyone can be saved, is the only relevant goal saving the most lives? Or can other factors be considered, at least as tiebreakers, such as how early in life the people we don't save will die or how much future life they are likely to lose? This commentary defends a multiprinciple allocation approach that considers objectives in addition to saving more lives, including preventing early death and preventing harm in the form (...) of lost future life. Particularly compared to an arbitrary, coin-flip tiebreaker, this multiprinciple approach more effectively prevents harm, prioritizes the worst-off, mitigates socioeconomic and racial health disparities, and tracks public values regarding allocation under scarcity—and is legally sound. -/- . (shrink)