Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care (...) left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource. (shrink)

Health systems need to set priorities fairly. This book makes the case that priority setting and rationing contribute significantly to the possibility of affordable and fair health care and that clinicians play an indispensable role in that process. The book depicts the results of a survey of European physicians about their experiences with rationing and other cost-containment strategies, and their perception of scarcity and fairness in their health care systems. Responding to and complementing these findings, commentators discuss why resource (...) allocation and bedside rationing is necessary and justifiable. The book explores how bedside rationing relates to clinical judgments about medical necessity and medical indications, marginal benefits, weak evidence-based medicine, and off-label use. The book highlights how comparative studies of health care systems can advance more effective and fair bedside rationing through learning from one another. (shrink)

This article draws attention to the limited amount of scholarship on what constitutes fairness and equity in resource allocation to health research by individual funders. It identifies three key decisions of ethical significance about resource allocation that research funders make regularly and calls for prioritizing scholarship on those topics – namely, how health resources should be fairly apportioned amongst public health and health care delivery versus health research, how health research resources should be fairly allocated between (...) health problems experienced domestically versus other health problems typically experienced by disadvantaged populations outside the funder's country, and how domestic and non-domestic health research funding should be further apportioned to different areas, e.g. types of research and recipients. These three topics should be priorities for bioethics research because their outcomes have a substantial bearing on the achievement of health justice. The proposed agenda aims to move discussion on the ethics of health research funding beyond its current focus on the mismatch between worldwide basic and clinical research investment and the global burden of disease. Individual funders’ decision-making on whether and to what extent to allocate resources to non-domestic health research, health systems research, research on the social determinants of health, capacity development, and recipients in certain countries should also be the focus of ethical scrutiny. (shrink)

The question of resource allocation is particularly pertinent to the realisation of socioeconomic rights. Perceptions of the place of resource allocation impact the adjudication of these rights. This article departs from the premise that with the adoption of the Optional Protocol to the International Covenant on Economic, Social and Cultural rights allowing individual communications and the establishment of the African Court on Human and Peoples’ Rights, there will be an increase in resource allocation questions (...) for adjudication. The article interrogates the experience of national courts and examines potential lessons that can be adopted at the international level to overcome the reluctance that supra-national tribunals may have when adjudicating on states obligations to fulfil. (shrink)

Resource allocation refers to assigning available resources for various uses and is a practice commonly applied in economics, management, and strategic planning.

This paper explores resource allocation complexities during health emergencies, focusing on pervasive racial disparities, notably affecting black communities. It aims to investigate alternatives to the Most Lives Saved approach, particularly its potential to exacerbate disparities. To analyse resource allocation strategies, the essay reviews the Dual-Principled System proposed by Bruce and Tallman (B+T) in 2021. B+T’s proposal critiques previous methods like the Area Deprivation Index and First Come First Serve while seeking to balance equity and utility by (...) adjusting triage scores based on diseases displaying racial disparities. However, the study identifies inherent challenges in subjectivity, complexity and fairness, necessitating a careful examination and potential innovative solutions. The examination of the Dual-Principled System uncovers challenges, leading to the identification of three main issues and potential solutions. Furthermore, to address subjectivity concerns, it is necessary to adopt objective disease selection criteria through data analysis. Moreover, proposed solutions for complexity include real-time data updates, adaptability and regional considerations. Fairness concerns can be mitigated through educational campaigns and a lottery system integrated with triage score adjustments. The study emphasises nuanced resource allocation with objective disease selection, adaptable strategies and educational initiatives, including a lottery system, aligning with fairness, equity and practicality. As healthcare evolves, resource allocation must align with justice, fostering inclusivity and responsiveness for all. (shrink)

This article examines the inherently ethical nature of resource allocation in policing. Decision-makers must make trade-offs between values such as efficiency vs. equity, individual vs. collective benefit, and adopt principles of distribution which allocate limited resources fairly. While resource allocation in healthcare has been the subject of extensive discussion in both practitioner and academic literature, ethical resource allocation in policing has received almost no attention. We first consider whether approaches used in healthcare settings would (...) be suitable for policing. Whilst there are some high-level similarities in the relevant ethical considerations and processes—such as aiming for efficient and equitable resource deployment—there are also fundamental differences between the two settings, which we argue necessitate a different approach. These differences include: (1) greater diversity and incommensurability of the benefits of policing, (2) more frequent non-linearity in returns on policing investment, (3) greater “ethical divisibility” (permissible scaling down) of programs in policing, (4) a requirement to assess “need” for policing resources at the collective (rather than individual) level, and (5) clearer primacy of equity considerations in policing. Having drawn out the implications of these differences, we sketch some tentative proposals for ethical resource allocation in policing. (shrink)

The Covid-19 pandemic has led to a health crisis of a scale unprecedented in post-war Europe. In response, a large amount of healthcare resources have been redirected to Covid-19 preventive measures, for instance population-wide vaccination campaigns, large-scale SARS-CoV-2 testing, and the large-scale distribution of protective equipment to high-risk groups and hospitals and nursing homes. Despite the importance of these measures in epidemiological and economic terms, health economists and medical ethicists have been relatively silent about the ethical rationales underlying the large-scale (...) allocation of healthcare resources to these measures. The present paper seeks to encourage this debate by demonstrating how the resource allocation to Covid-19 preventive measures can be understood through the paradigm of the Rule of Rescue, without claiming that the Rule of Rescue is the sole rationale of resource allocation in the Covid-19 pandemic. (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.

Resource allocation has always been a key technology in wireless sensor networks, but most of the traditional resource allocation algorithms are based on single interface networks. The emergence and development of multi-interface and multichannel networks solve many bottleneck problems of single interface and single channel networks, it also brings new opportunities to the development of wireless sensor networks, but the multi-interface and multichannel technology not only improves the performance of wireless sensor networks but also brings great (...) challenges to the resource allocation of wireless sensor networks. Edge computing changes the traditional centralized cloud computing processing method into a method that reduces computing storage capacity to the edge of the network and faces users and terminals. Realize the advantages of lower latency, higher bandwidth, and fast response. Therefore, this paper proposes a joint optimization algorithm of resource allocation based on edge computing. We establish a wireless sensor allocation model and then propose our algorithm model combined with the advantages of edge computing. Compared with the traditional allocation algorithm, it can further improve the resource utilization, reduce the network energy consumption, increase network capacity, and reduce the complexity of the schemes. (shrink)

Resource Allocation Mechanisms derives the general welfare properties of systems in which individuals are motivated by self-interest. Satisfactory outcomes will emerge only if individual incentives are harnessed by means of a communication and payoff process, or mechanism, involving every agent. Professor Campbell employs a formal and abstract model of a mechanism that brings into prominence the criteria by which the performance of an economy is to be judged. The mechanism approach is used to prove some fundamental theorems about (...) the possibility of designing an economic system satisfying the criteria. It also establishes a way of thinking about economic issues that is becoming increasingly useful in special branches of economics, such as industrial organization and public finance. This book can be viewed as two different texts: one constitutes an introduction to the theory of mechanism design and the other is a treatment of welfare economics with conventional emphasis on Pareto optimality as well as providing substantial material on incentives, uncertainty, and existence of equilibrium. (shrink)

In a much cited phrase in the famous English ‘Child B’ case, Mr Justice Laws intimated that in life and death cases of scarce resources it is not sufficient for health care decision-makers to ‘toll the bell of tight resources’: they must also explain the system of priorities they are using. Although overturned in the Court of Appeal, the important question remains of the extent to which health-care decision-makers have a duty to give reasons for their decisions. In this paper, (...) I examine the philosophical foundations of the legal obligation to give reasons in English law. Why are judges sometimes supportive of the imposition of a duty to give reasons and sometimes not? What is it about the context of life and death health care allocation problems that makes it unsuitable in their view for such a duty; and is this stance justified? What is it to give a reason for a decision? I examine Frederick Schauer’s account of reason-giving in terms of generalisation and commitment and I suggest that it provides an overstated account of what giving a reason commits one to. I go on to examine an idea of judicial creation: that where value judgements are “inexpressible” there is a strong reason not to impose a duty to give reasons on to public bodies. The strongest case for a duty to give reasons is in terms of the value of respect for citizens. I argue that there is nothing in the very nature of reason-giving that ought to preclude the imposition of such a duty in this context, but concede that there is a serious danger of legalism that could result in a hamstringing of health care decision-making. It is up to judges and lawyers to seek to avoid this danger. (shrink)

The problem of resource allocation in health has stimulated much thought and research, in attempts to provide objective, rational methods by which necessary choices can be made. One such method was proposed in a paper in this journal. The authors argued for a utilitarian approach, which they claimed to demonstrate was acceptable to society at large. This paper argues that the evidence supporting such a claim was flawed; such a utilitarian approach is not socially acceptable, and is therefore (...) not relevant. Rather more relevant directions for research are discussed, based on the assertion that a degree of realism is essential when considering the problems of resource allocation. (shrink)

This paper deals with the problem of optimal control of R&D. The fundamental aspects of this problem are viewed as: uncertainty about economic parameters of new technology (or new activity, e.g. a search for new oil fields) explored by a group of parallel projects attempting to make advances in this technology as well as improve economic data; allocation of investments among rival projects under a given total budget; timing of the ultimate selection of new technology (activity) according to the (...) most successful project. The process of data improvement (PDI) is described as a (random) process of reducing the intervals of uncertainty, the rate of data improvement being controlled, in effect, by the investment policy. A stationary dynamic model with infinite horizon of planning and with the criterion of total discounted costs is developed. The model is carefully investigated from the economic point of view, and some new effects are discovered. It is demonstrated that uncertainty may be the source of additional gain; the bigger the initial uncertainty, the bigger the gain may be under optimal control. This effect is based on PDI, the economic background of which is presented as multiplication of the expected gain over time, which is typical for the classical macromodels of economics.Optimal continuous control is constructed at every time moment, and answers to two main questions are given:(1) either to prolong R & D or to make ultimate selection of one project, (2) how to allocate resources among the rival projects in the case of R&D prolongation. The last question is answered on the basis of profitability indices that relate efficiencies of PDI for particular projects to the costs of information. (shrink)

Health systems contribute to the environmental crisis. Yet, addressing this problem seems to generate a resource allocation dilemma for hospitals: investing in healthcare delivery seems to mean sacrificing environmental goods, and vice versa. We question this zero‐sum thinking. After presenting the benefits of investing in the two seemingly competing goods—environmental goods and health goods—we propose that the apparent dilemma arises due to a tendency to think in dualisms. Consequently, health and environmental goods seem, respectively, to correspond to opposing (...) sides of four dualisms: human/nature, local/global, present/future and therapy/prevention. We argue, instead, that a relational frame that considers the human person in their relational context should be used to approach the problem. A relational understanding of the human person as a meaning‐making subject in relationship to all that is shows us that choosing between either health goods or environmental goods is frequently a false dichotomy: both can serve the well‐being of human beings adequately understood. Such an approach, then, widens our conception of health and healthcare to include environmental goods. This wider conception of health and healthcare means that hospitals should (1) look for co‐benefits in the first instance when allocating resources, thereby often resolving zero‐sum thinking that gives rise to the competing goods dilemma, and (2) in the remaining cases where co‐benefits are not achievable, use classic resource allocation principles, such as proportionality of benefits and burdens, to reach allocation decisions about a now wider range of goods (i.e., health and environmental, rather than merely health goods). (shrink)

In a recent line of cases, senior judges in the UK have been called upon to adjudicate in complaints over the failure of health and local authorities to meet the welfare needs of citizens. Local authorities claimed that the disputes had been precipitated by a lack of resources allocated by central government to meet local demand. This article examines the role of the courts in resolving a fundamental tension between central government policy of financial cost-cutting on the one hand and (...) welfarist principles embodied in legislation for the delivery of public services on the other. Questions are raised about the relevance and appropriateness of rights-based adjudication in welfare needs contexts and about the reluctance of courts to intervene in the resolution of resource allocation disputes even where fundamental rights, particularly in areas such as health, community care, and education where notions of rights are inextricably bound up with use of financial resources. These key cases have arisen prior to the implementation of the Human Rights Act 1998. Where relevant, the likely impact of the Act on welfare needs disputes is considered. (shrink)

Public discussion of resourcing in healthcare tends to compound ideas of resource allocation and rationing. Public debate also tends to focus on situations of scarcity such as lack of kidneys or hearts for transplantation, or heated arguments regarding whether the latest very expensive new drug should be made available, regardless of cost, to treat certain condition such as cystic fibrosis or a particular type of cancer. The idea that nursing or medical time is an important healthcare resource (...) that needs to be allocated with care rarely gets an effective airing in public debate.I argue in this chapter that it is important in the healthcare context to differentiate resource allocation from rationing, on the basis that if we assume we are rationing healthcare as our starting point we may miss opportunities to examine more and less effective ways of allocating the healthcare resource. This is particularly important in nursing care where failure to examine carefully how the nursing resource is allocated, and supported, is leading to covert rationing of nursing time and suboptimal patient care in hospitals across Europe. (shrink)

Park and Davies (2024) discuss the allocation of scarce resources during a pandemic—primarily ventilators and healthcare staff—and assess the ethical concepts that are used in arguments for and aga...

This paper maps the different levels of the problem of healthcare resource allocation — micro, macro and international — with reference to three cases. It is argued that two standard approaches to the issue of distributive justice in healthcare, the QALY (quality-adjusted life year) approach and the social-contract approach developed by Norman Daniels, are fundamentally unsatisfactory for reasons identified by Alasdair MacIntyre. Although the virtue theory articulated by MacIntyre and others has been influential in many areas of healthcare (...) ethics, there seems to have been relatively little discussion of the difference it might make to the problems of resource allocation. The potential of such an approach is explored in the later sections of the paper. Two apparently promising ways of bringing virtue ethics to bear on resource allocation are examined and found wanting to greater or lesser extents. Firstly, Beauchamp and Childress’s account of the virtues as a supplement to their ‘Four Principles’ is found to have little or no substantive contribution to make to this issue. Secondly, the ‘liberal communitarian’ system of resource allocation proposed by Ezekiel Emanuel, while a considerable improvement on the account of Beauchamp and Childress, remains problematic in some respects. An alternative Christian account is developed by identifying significant influences that might shape the ‘political prudence’ which would enable Christian communities to form sound judgments about distributive justice in healthcare. The paper concludes with some remarks about the relationship between this tradition-constituted account and the wider public sphere of policy-making and practice. (shrink)

Judgement T-237/23 of the Constitutional Court of Colombia responds to a tutela petition filed by a group of 26 people over the age of 60, disabled and/or chronically ill, against the Colombian Ministry of Health and Social Protection. It identifies the lack of binding recommendations on triage by the Ministry, which enabled, among other things, the development and use of a set of triage criteria that are suspected to undermine the rights of certain populations. This article aims to link the (...) contested triage criteria to the so-called ‘standard view of disability’ to show the ethical and epistemic problems of establishing prioritisation or tie-breaker criteria for the scarce health resources allocation based on scores related to a person’s quality of life or ‘functional independence’. To do so, I will focus on the ethical recommendations elaborated by Grupo Intensivistas Antioquia and the Mayor’s Office of Medellín that have been challenged in the tutela petition and the third section of Judgement T-237/23. (shrink)

With a growing number of genetic tests becoming available to the health and consumer markets, genetic health care providers in Canada are faced with the challenge of developing robust decision rules or guidelines to allocate a finite number of public resources. The objective of this study was to gain Canadian genetic health providers' perspectives on factors and criteria that influence and shape resource allocation decisions for publically funded predictive genetic testing in Canada. The authors conducted semi-structured interviews with (...) 16 senior lab directors and clinicians at publically funded Canadian predictive genetic testing facilities. Participants were drawn from British Columbia, Alberta, Manitoba, Ontario, Quebec and Nova Scotia. Given the community sampled was identified as being relatively small and challenging to access, purposive sampling coupled with snowball sampling methodologies were utilized. Surveyed lab directors and clinicians indicated that predictive genetic tests were funded provincially by one of two predominant funding models, but they themselves played a significant role in how these funds were allocated for specific tests and services. They also rated and identified several factors that influenced allocation decisions and patients' decisions regarding testing. Lastly, participants provided recommendations regarding changes to existing allocation models and showed support for a national evaluation process for predictive testing. Our findings suggest that largely local and relatively ad hoc decision making processes are being made in relation to resource allocations for predictive genetic tests and that a more coordinated and, potentially, national approach to allocation decisions in this context may be appropriate. (shrink)

In all western countries health care budgets are under considerable constraint and therefore a reflection process has started on how to gain the most health benefit for the population within limited resource boundaries. The field of ethics of resource allocation has evolved only recently in order to bring some objectivity and rationality in the discussion. In this article it is argued that priority setting is the prerequisite of ethical resource allocation and that for purposes of (...) operationalization, instruments such as need assessment and health technology assessment (HTA) are essential worktools for making more rational decisions. Thresholds (deduced from the need assessment and HTA) are - within this context - guiding but not binding principles. -/- Discussion of theoretical concepts of not only priority setting, need assessment and HTA complemented by practical examples for showing the challenges and the need, but also the chances of a more explicit and transparent policy of resource allocation in health care. Results: Priority setting in health care is based on the values of equity, justice and solidarity. Health packages decisions are determined from medical need (the severity of the condition) and/or the appropriateness of medical interventions (their cost-effectiveness). With growing awareness that originally effective and cost-effective services and programmes are eventually provided inappropriately, the focus is shifting towards the organisational aspects of provision and application. Therefore, need assessment is based on the distinction of health care needs from demand, supply, or actual care. Additionally HTA provides the evidence on health care interventions in a way that it becomes obvious who benefits from an intervention and who definitely does not benefit, but eventually is harmed. -/- Health services research on effective and cost-effective interventions and research/monitoring of performance that the effective and cost-effective services are provided appropriately are of increasing importance for guiding the decision-making process on priority setting and need assessment. Effective healthcare for all is sustainable, if we start to put expenditures in perspective and focus health policies and research strategies on managing expectations through patient information and a more realistic notion of medical advancements and, on the other hand, on encouraging need-based and cost-effective innovations. (shrink)

We examine people’s attitudes toward AI-based algorithms as a means to allocate scarce resources. Through a vignette experiment, we confront respondents with five scenarios in which an AI-based algorithm allocates various goods and ask them if they find this morally desirable. We compare people’s moral attitudes toward AI with their attitudes toward a friend, a waiting list, a lottery, and the market. Our results show that people rank allocations through AI as morally clearly less desirable than most alternatives. This is (...) especially true for goods that are nonessential to a person’s survival. One potential explanation for the identified algorithm aversion is that AI is considered more opaque than its alternatives, and that an allocation mechanism’s moral rejection increases if its working is less well understood. Together, our results suggest that using AI to allocate resources, especially nonessential ones, is likely to meet substantial social resistances. To understand the reasons, researchers should systematically study laypeople’s moral intuitions about algorithms, a field we call folk algorithmics. (shrink)

The literature on the ethics of machine learning in healthcare contains a great deal of work on algorithmic fairness. But a focus on fairness has not been matched with sufficient attention to the relationship between machine learning and distributive justice in healthcare. A significant number of clinical prediction models have been developed which could be used to inform the allocation of scarce healthcare resources. As such, philosophical theories of distributive justice are relevant when considering the ethics of their design (...) and implementation. This paper considers the relationship between machine learning in healthcare and distributive justice with a focus on four aspects of algorithmic design and deployment: the choice of target variable, the model's socio-technical context, the choice of input variables, and the membership of the datasets that models are trained and validated on. Procedural recommendations for how these considerations should be accounted for in the design and implementation of such models follow. (shrink)

As resources in health care are scarce, managers and clinicians must make difficult choices about what to fund and what not to fund. At the level of a regional health authority, limited approaches to aid decision makers in shifting resources across major service portfolios exist. A participatory action research project was conducted in the Calgary Health Region. Through five phases of action, including observation of senior management meetings, as well as two sets of one-on-one interviews and two focus groups, an (...) approach to priority setting at the macro level within the health region was developed and implemented. The resulting macro level approach builds on the program budgeting and marginal analysis (PBMA) framework. Using a multi-disciplinary expert panel, about $45M (CAN) was released for the 2002/03 fiscal year and made available for re-allocation to service growth areas and the deficit. Important qualitative themes from the managers and clinicians informed both process development and refinement. The approach developed here not only facilitated re-allocation of resources, but also drew in both clinicians and managers to work together on this challenging task. The approach is pragmatic, transparent and evidence based, and should have application elsewhere. (shrink)

This paper describes the present resource allocation problems in the Danish tax-based public health care system and presents an analysis of the two policy options put forward as a solution to these problems: (1) explicit rationing of services, and (2) the introduction of two-tiered health care. It is argued that a two-tiered system with a private second tier is unlikely to be acceptable and viable in Denmark, whereas an introduction of a second tier within the public system may (...) be more acceptable. It is further argued that present implicit rationing methods may be unethical and ought to be replaced by explicit rationing. Keywords: justice, resource allocation, two-tiered health care CiteULike Connotea Del.icio.us What's this? (shrink)

Issues of resource allocationResource allocation, triageTriage, and rationingRationing decisions are common in the context of disasters and public healthPublic health emergencies, such as pandemics. However, to date, the majorityMajority of the literature focuses on an adult population with very little attention given to a pediatric population or to a population that may be mixed: adults and children. Furthermore, decisions of rationingRationing scarce resources do not only occur during disasters and other wide-scale emergencies. Such decisions are commonplace in pediatric (...) organ transplantation and can creep into areas of experimental medicine, such as xenotransplantation. This chapter explicates differences between pediatric and adult triageTriage decisions by first looking at the trifold issues of resource allocationResource allocation, triageTriage, and rationingRationing decisions mainly in the context of a disaster situation or public healthPublic health emergency. However, the issues of pediatric organ transplantation, health disparitiesHealth disparities, and experimental medicine will also be covered. (shrink)

Scarce resource allocation policies vary across the United States. Little is known about regional variation in resource allocation protocols and variation in their application. We sought to evaluat...

The impact of machine learning in healthcare on patient informed consent is now the subject of significant inquiry in bioethics. However, the topic has predominantly been considered in the context of black box diagnostic or treatment recommendation algorithms. The impact of machine learning involved in healthcare resource allocation on patient consent remains undertheorized. This paper will establish where patient consent is relevant in healthcare resource allocation, before exploring the impact on informed consent from the introduction of (...) black box machine learning into resource allocation. It will then consider the arguments for informing patients about the use of machine learning in resource allocation, before exploring the challenge of whether individual patients could principally contest algorithmic prioritization decisions involving black box machine learning. Finally, this paper will examine how different forms of opacity in machine learning involved in resource allocation could be a barrier to patient consent to clinical decision-making in different healthcare contexts. (shrink)

Some Comments on de Melo-Martin and Harris.

The use of ethics in everyday nursing practice will become increasingly important to the individual nurse, and nursing as a profession, as technology has a greater impact on health status and the provision of health care. Resource allocation is only one example of an ethical issue in which nursing must have input. Nursing can expand its contribution to society by ensuring that it plays a major role in shaping public policy and legislation. If nursing is to continue to (...) serve the public, the involvement of nurses within the political process must be accepted as an ethical necessity. (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)

In healthcare, a tension sometimes arises between the injunction to do as much good as possible with scarce resources and the injunction to rescue identifiable individuals in immediate peril, regardless of cost (the “Rule of Rescue”). This tension can generate serious ethical and political difficulties for public policy makers faced with making explicit decisions about the public funding of controversial health technologies, such as costly new cancer drugs. In this paper we explore the appropriate role of the Rule of Rescue (...) in public resource allocation decisions by health technology funding advisory bodies such as the National Institute for Health and Clinical Excellence. We consider practical approaches to operationalising the Rule of Rescue from Australia and the UK before examining the relevance of individual moral imperatives to public policy making. We conclude that that whilst public policy makers in a humane society should facilitate exceptional departures from a cost effectiveness norm in clinical decisions about identified individuals, it is not so obvious that they should, as a matter of national public policy, exempt any one group of unidentified individuals within society from the rules of opportunity cost at the expense of all others. (shrink)

Resource allocation decisions are often made on the basis of clinical and cost effectiveness at the expense of ethical inquiry into what is acceptable. This paper proposes that a more compassionate model of resource allocation would be achieved through integrating ethical awareness with clinical, financial and legal input. Where a publicly-funded healthcare system is involved, it is suggested that having an agency that focuses solely on cost-effectiveness leaving medical, legal and ethical considerations to others would help (...) depoliticise rationing decisions and command greater public acceptance. (shrink)

The question of how to allocate scarce medical resources has become an important public policy issue in recent decades. Cost-Utility Analysis is the most commonly used method for determining the allocation of these resources, but this book counters the argument that overcoming its inherent imbalances is simply a question of implementing methodological changes. The Economics of Resource-Allocation in Healthcare represents the first comprehensive analysis of equity weighting in health care resource allocation that offers a fundamental (...) critique of its basic framework. It offers a heterodox account of health economics, putting the discourse on economic evaluation into it broader socio-political context. Such an approach broadens the debate on fairness in health economics and ties it in with deeper rooted problems in moral philosophy. Ultimately, this interdisciplinary study calls for the adoption of a fundamentally different paradigm to address the distribution of scarce medical resources. This book will be of interest to policy makers, health care professionals or Post-Graduate students looking to broaden their understanding of the economics of the healthcare system. (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)

Objective: A deep understanding of the relationship between a scarce drug's dose and clinical response is necessary to appropriately distribute a supply-constrained drug along these lines. Summary of key data: The vast majority of drug development and repurposing during the COVID-19 pandemic – an event that has made clear the ever-present scarcity in healthcare systems –has been ignorant of scarcity and dose optimisation's ability to help address it. Conclusions: Future pandemic clinical trials systems should obtain dose optimisation data, as these (...) appear necessary to enable appropriate scarce resource allocation according to societal values. (shrink)

On March, 24, 2020, 818 cases of COVID-19 had been reported in New South Wales, Australia, and new cases were increasing at an exponential rate. In anticipation of resource constraints arising in clinical settings as a result of the COVID-19 pandemic, a working party of ten ethicists was convened at the University of Sydney to draft an ethics framework to support resource allocation decisions. The framework guides decision-makers using a question-and-answer format, in language that avoids philosophical and (...) medical technicality. The working party met five times over the following week and then submitted a draft Framework for consideration by two groups of intensivists and one group of academic ethicists. It was also presented to a panel on a national current affairs programme. The Framework was then revised on the basis of feedback from these sources and made publicly available online on April 3, ten days after the initial meeting. The framework is published here in full to stimulate ongoing discussion about rapid development of user-friendly clinical ethics resources in ongoing and future pandemics. (shrink)

Large language models (LLMs) hold the potential to transform clinical medicine, but their capacity to amplify societal biases is a significant concern, particularly in the ethically sensitive domain of clinical resource allocation. A critical knowledge gap exists in the quantitative understanding of how these models weigh non-clinical factors in forced-choice ethical dilemmas. This study provides a large-scale, systematic evaluation of a leading LLM to measure its implicit biases in resource allocation decisions. We conducted a cross-sectional, in-silico (...) analysis using OpenAI’s GPT-5 model. Seven clinical vignettes representing scarce resource scenarios were paired with 3,888 unique patient profiles generated from a full-factorial combination of seven demographic and social variables (age, gender, race, income, dependents, education, social support). This resulted in 13,608 unique A/B patient comparisons. We used pooled logistic and linear regression models to identify the primary drivers of the model’s allocation choices and quantify the magnitude of biases. The stability and internal consistency of the model’s judgments were also assessed. The LLM’s decisions were governed by a distinct hierarchy of non-clinical factors. Patient age, income, and number of dependents were the most powerful predictors. Being 25 years old increased the odds of selection more than threefold compared to a 50-year-old (OR 3.31; 95% CI, 2.96–3.71; p < 0.001), while earning over $5 million annually reduced the odds by 75% (OR 0.25; 95% CI, 0.22–0.28; p < 0.001). The model also systematically favored racial minorities, women, and non-binary individuals over White men. Analysis revealed significant internal inconsistency, with the model’s chosen patient matching its own higher-priority-scored patient in only 66.3% of cases overall. The influence of biases was highly context-dependent yet showed stochastic stability upon repeat testing. The tested model operates with a strong, opaque, and context-dependent set of non-clinical biases when faced with ethical dilemmas. These findings suggest that this architecture’s inconsistent and unpredictable ethical framework makes its direct integration into clinical decision support for resource allocation untenable at this stage. Rigorous standards for safety, transparency, and ethical validation are required before these technologies can be responsibly deployed in high-stakes clinical settings. (shrink)

The future clearly lies in restricting the introduction of new treatments into medical practice unless they are beneficial and an improvement over existing compounds, together with a stepwise re-evaluation of current therapies. The days of analogue development which give 10% or 15% improvement in toxicity over existing compounds are no longer acceptable, and resources should be preserved for real advances. These may require support in their development, particularly at the randomised controlled trial level, by government or research institutions in collaboration (...) with industry.Patients in general are now better informed by their physicians, nurse specialists and self-help groups, although few regions have gone as far as Oregon in information dissemination and involvement of patients in resource allocation decisions. We should take comfort from the fact that in spite of all the difficulty, new treatments continue to be developed, reflecting a commitment from the public, government and the private sector for continued progress. The way forward may be challenging, but the medical profession has to demonstrate leadership by countering the short-sightedness and over-regulation which has resulted from the recent economic recession. We should be seen to be acting with foresight in maintaining the quest for real improvement in the best interests of patients. Governments in turn have a responsibility to ensure they maintain independent bodies of professionals who have the qualities of flexibility, critical ability and vision to ensure continued development of high quality care. (shrink)

So far, this text has examined the foundations of ethical practice in history and professionalism. We then considered several specific topics: reproductive ethics, end of life, and conscience rights. This chapter will focus on certain specific additional topics not previously discussed. We’ll begin with the fascinating subject of vaccines and their ethical controversies. We’ll then discuss ethical controversies arising during a pandemic crisis, followed by the ethics of unproven treatments.

Volume 20, Issue 7, July 2020, Page 86-88.

The Infectious Diseases Act entered into force officially on 14 November 2018 in Bangladesh. The Act is designed to raise awareness of, prevent, control, and eradicate infectious or communicable diseases to address public health emergencies and reduce health risks. A novel coronavirus disease was first identified in Bangladesh on 8 March 2020, and the Ministry of Health and Family Welfare issued a gazette on 23 March, listing COVID-19 as an infectious disease and addressing COVID-19 as a public health emergency. The (...) gazette empowers the government to monitor the spread of infection. Despite there being an infrastructure of research ethics committees in almost all hospitals in Bangladesh, a lack of such committees in the clinical setting often forces healthcare professionals to allocate scarce healthcare resources to the task. These personnel are often either influenced by materialistic matters or guided by the emergency policies, without reaching a consensus on how to allocate scarce resources in times of need, especially in the time of the COVID-19 pandemic. Ethical dilemmas often arise when a number of patients with COVID-19, especially in poor and middle-class areas, are denied care while elites are prioritized to receive such scarce resources. Resource allocation in healthcare during the COVID-19 pandemic in Bangladesh appears to be unethical and in direct conflict with the biomedical principles of non-maleficence and procedural justice. The findings of this study suggest that the Act needs substantive changes in the stipulation of policy directing hospitals in the provision of resource allocation framework. Furthermore, parliament should produce guidance outlining how to successfully implement the law with the aim of protecting public health in times of emergency, especially the COVID-19 pandemic. (shrink)

Objective To compare the perspectives of medical students in the preclinical and clinical phases of medical training on the issue of rationing scarce medical resources in times of crisis. Methods Questionnaire-based cross-sectional study. Results A total of 201 participants took part in the study, with 100 participants in the preclinical phase group, and 101 in the clinical phase group. A multivariable analysis found that just 14.9% (n = 34) of the clinical phase students were willing to give a short-supplied blood (...) unit to the first-arrived patient to the emergency department when more patients are expected compared to 63.9% in the preclinical group (n = 62) ( p < 0.001, OR = 0.75 95% CI: 0.029−0.192). Seventy-four percent (n = 74) of the clinical phase students were found to be willing to remove a patient from a respirator to allocate it to an ill child compared to 35.7% (n = 35) in the preclinical phase group ( p < 0.001, OR = 4.168 95% CI: 1.931−8.998). Of the clinical phase group, 46.6% (n = 41) were willing to allocate a short supplied flu medicine to a patient with poor prognosis compared to 57.7% (n = 56) in the preclinical phase group ( p = 0.04, OR = 0.457 95% CI: 0.216−0.966). Conclusion Clinical exposure during training may affect the way medical students make ethical decisions, independent of age, sex, as well as marital and parental status. (shrink)

The dynamics of resource allocation to pictures of spiders and other animals in spider-fearful participants was investigated. The task of the participants was to respond rapidly and accurately to various probe stimuli superimposed on pictures of different animals. These were arguably fear relevant (spiders, snakes, and wolves) and fear irrelevant (beetles, turtles, and rabbits). The probes were shown with different stimulus onset asynchronies (SOAs) from picture onset to address the dynamics of resource allocation. A larger (...) class='Hi'>allocation of resources to spider pictures than to pictures of all other animals, with no difference between the latter regarding resource allocation was found. For the task that demanded more resources the fear-related physiological responses decreased, suggesting that controlled processing modulates fear responses. (shrink)