ArticleAnnals of internal medicine2009
Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions.
Article in Annals of internal medicine, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 105 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
105 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Practices in Triage and Transfer of Critically Ill Patients: A Qualitative Systematic Review of Selection Criteria.Critical care medicine · 2020Pooled it
- [Ethical recommendations for a difficult decision-making in intensive care units due to the exceptional situation of crisis by the COVID-19 pandemia: A rapid review & consensus of experts].Medicina intensiva · 2020Guideline
- Variation in Ventilator Allocation Guidelines by US State During the Coronavirus Disease 2019 Pandemic: A Systematic Review.JAMA network open · 2020Pooled it
- Bolstering agreement with scarce resource allocation policy using education: a post hoc analysis of a randomized controlled trial.BMC health services research · 2025Trial
- Clinical phenotypes and severity stratification in pediatric diethylene glycol poisoning: a latent class analysis of the Gambia acute kidney injury outbreak.Pediatric nephrology (Berlin, Germany) · 2026Article
- Proposed intensive care unit triage models lack predictive validity for hospital mortality to deal with catastrophes: insights from a cohort study.Critical care science · 2026Article
- Multicultural ethics in crisis: prioritizing ECMO allocation and the role of critical consciousness.International journal for equity in health · 2025Article
- On value compatibility: reflections on the ethical framework for pandemic healthcare distribution.Medicine, health care, and philosophy · 2025Article
- Optimizing emergency response systems in urban health crises: A project management approach to public health preparedness and response.Medicine · 2025Review
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- Development, deployment, and continuous monitoring of a machine learning model to predict respiratory failure in critically ill patients.JAMIA open · 2024Article
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- What are the views of Quebec and Ontario citizens on the tiebreaker criteria for prioritizing access to adult critical care in the extreme context of a COVID-19 pandemic?BMC medical ethics · 2024Article
- Balancing the benefits of vaccination: AnPNAS nexus · 2024Article
- Ethical dilemmas in prioritizing patients for scarce radiotherapy resources.BMC medical ethics · 2024Article
- Patient Admission and Mechanical Ventilator Allocation Decision-Making Processes by Frontline Medical Professionals in a Japanese ICU During the COVID-19 Pandemic: A Qualitative Study.Qualitative health research · 2023Article
- Exploring the clinical benefit of ventilation therapy across various patient groups with COVID-19 using real-world data.Scientific reports · 2023Article
- Experiences of US Clinicians Contending With Health Care Resource Scarcity During the COVID-19 Pandemic, December 2020 to December 2021.JAMA network open · 2023Article
- After the Deluge: Leveraging Lessons from the COVID-19 Pandemic to Build the Trust of North Carolina's Disability Community.North Carolina medical journal · 2023Article
45 more citing papers are in PubMed but not listed here.
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Authors and funding
4 authors.
Funding
Abstract
A public health emergency, such as an influenza pandemic, will lead to shortages of mechanical ventilators, critical care beds, and other potentially life-saving treatments. Difficult decisions about who will and will not receive these scarce resources will have to be made. Existing recommendations reflect a narrow utilitarian perspective, in which allocation decisions are based primarily on patients' chances of survival to hospital discharge. Certain patient groups, such as the elderly and those with functional impairment, are denied access to potentially life-saving treatments on the basis of additional allocation criteria. We analyze the ethical principles that could guide allocation and propose an allocation strategy that incorporates and balances multiple morally relevant considerations, including saving the most lives, maximizing the number of "life-years" saved, and prioritizing patients who have had the least chance to live through life's stages. We also argue that these principles are relevant to all patients and therefore should be applied to all patients, rather than selectively to the elderly, those with functional impairment, and those with certain chronic conditions. We discuss strategies to engage the public in setting the priorities that will guide allocation of scarce life-sustaining treatments during a public health emergency.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.