PharmacoEconomics & Outcomes News 572 - 21 Feb 2009

Can scarce medical interventionsbe allocated justly?

A multiprinciple framework must be implemented toachieve a just allocation of scarce medical interventions,suggest researchers from the Department of Bioethics atthe National Institutes of Health, US.

In their article discussing principles for allocation ofscarce medical interventions, they identify and evaluateeight simple ethical principles that can be classified intofour categories according to their core ethical values:treating people equally (allocation by lottery; first-come,first-served principle), favouring the worst-off (sickest-first allocation; youngest-first allocation), maximisingtotal benefits (save-the-most-lives principle; save-the-most-life-years principle), and promoting and rewardingsocial usefulness (instrumental-value allocation;reciprocity allocation). The researchers note that nosingle principle "is sufficient on its own to recognise allmorally relevant considerations".

Multiprinciple allocation systems neededThe researchers suggest that morally relevant simple

principles must be combined into multiprincipleallocation systems. But none of the existingmultiprinciple allocation systems (based on quality-adjusted life-years, based on disability-adjusted life-years or the UNOS* points systems used for organallocation) satisfy all ethical requirements for justallocation, say the researchers.

The researchers therefore propose the complete livessystem as a multiprinciple framework that combinesfour morally relevant principles (youngest-first, save-the-most-life-years, lottery and save-the-most-lives).Furthermore, in a public health emergency, such asystem would allocate scarce interventions to peopleinstrumental in realising these four principles. "Toachieve a just allocation of scarce medical interventions,society must embrace the challenge of implementing acoherent multiprinciple framework rather than relyingon simple principles or retreating to the status quo,"conclude the researchers.* United Network for Organ Sharing

Persad G, et al. Principles for allocation of scarce medical interventions. Lancet373: 423-431, No. 9661, 31 Jan 2009 801020911

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PharmacoEconomics & Outcomes News 21 Feb 2009 No. 5721173-5503/10/0572-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved