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PurposeThe current COVID-19 pandemic stressed the importance of discussing the problems surrounding the scarcity of healthcare resources. Healthcare rationing has been a constant issue, but in the present pandemic, the need to choose who to treat and who to let die became a pressing reality. What criteria to adopt or what protocol to follow is a difficult challenge politicians face because it involves moral judgments and/or ethical values. As there are multiple ethically permissible criteria to allocate life-saving medical resources and we will all bear the consequences of these rationing decisions, it is important to explore the appropriateness of each of these approaches. Here, the author describes the main rationing criteria proposed in the literature and explores their applicability to an absolute scarcity of resources as the current one. Finally, the author describes the ongoing COVID-19 pandemic in Portugal and proposes some guidelines to ensure a fair allocation of resources.Design/methodology/approachA literature review was made regarding some rationing protocols, and a qualitative research was followed to collect data regarding the number of daily infected and daily deaths by COVID-19.FindingsPortugal has not, fortunately and so far, been as badly hit by COVID-19 as other European Countries. However a rigorous and explicit protocol is lacking to help health professionals at the frontline to take legitimate rationing decisions.Practical implicationsThe author contributes for the discussion about life-or-death decisions by proposing some clinical practice lines that may be applied fairly and consistently.Originality/valueThis study is the first attempt to emphasize the need to set life-or-death guidelines in Portugal in a public health emergency and to propose some of these guidelines.

This paper tests the factorial structure of a questionnaire comprising seven health care rationing criteria (waiting time, ‘rule of rescue’, parenthood of minors, health maximization, youngest first, positive and negative version of social merit) and explores the adherence to them of 254 Portuguese health care professionals, when considered individually and when confronted with two-in-two combinations. Data were collected through a self-administered questionnaire where respondents faced hypothetical rationing dilemmas comprising one rationing criterion and dichotomous options pairs with two rationing criteria. Confirmatory factor analysis and multinomial logistic regressions were used to validate the structure of the questionnaire and the data. The findings suggest that: (i) the hepta-factorial structure of the questionnaire presented a good fit of the data; and (ii) support for rationing criterion depends on whether they are individually considered or confronted in dichotomous options pairs. When only one criterion distinguishes the patients, healthcare professionals support six criteria (by descending order): waiting time, rule of rescue, health maximization, penalization of patients’ risky behaviors, youngest first and being parent of a young child. When two criteria were confronted, immediate threat of life/health and large expected benefits were the most preferred. Conversely, the positive version of social merit was an unappreciated rationing criterion.

2015),"Suicide rates for different religious groups in the South Asian origin population in England and Wales: a secondary analysis of a national data set"Access to this document was granted through an Emerald subscription provided by emerald-srm:451335 [] For AuthorsIf you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.comEmerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services.Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation. AbstractPurpose -The purpose of this paper is to seek to elicit, in a context of economic crisis, the social preferences for the microallocation of scarce healthcare resources. Design/methodology/approach -Data were collected from an online questionnaire which includes a hypothetical rationing choice scenario with four patients differentiated by their personal characteristics and health states competing for treatments and a set of statements that embodies: distributive criteria for prioritizing patients; the authorship of these types of decisions; and the likelihood of these decisions to be taken. Descriptive statistics, factor analysis and non-parametric test were used for describing and validating the data. Findings -Findings suggest that respondents: support a pluralism of distributive principles in prioritizing patients with an incident in utilitarianism and the reducing of inequalities in health, translated in the fair-inning and in emotional arguments of fragility; trust in the health professional to make prioritization decisions; and are conscious that rationing decisions will be real in the short term. Practical implications -The pursuit of efficiency and the equalizing of a lifetime health seem to be the criteria that should guide any rationing policy at the micro level. Originality/value -This study addresses simultaneously several ethical principles inherent to microallocation healthcare resources in a suitable context in which Portugal is facing an economic crisis and where, consequently, rationing healthcare policies gain prominence on the political agenda.

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