The Fair Allocation of Scarce Medical Resources: A Comparative Study From Jordan

Abstract

The allocation strategies during challenging situations among the different social groups is based on 9 principles which can be considered either individually: sickest first, waiting list, prognosis, youngest first, instrumental values, lottery, monetary contribution, reciprocity, and individual behavior, or in combination; youngest first and prognosis, for example. In this study, we aim to look into the most important prioritization principles amongst different groups in the Jordanian population, in order to facilitate the decision-making process for any potential medical crisis. We conducted an online survey that tackled how individuals would deal with three different scenarios of medical scarcity: (1) organ donation, (2) limited hospital beds during an influenza epidemic, and (3) allocation of novel therapeutics for lung cancer. In addition, a free-comment option was included at the end of the survey if respondents wished to contribute further. Seven hundred and fifty-four survey responses were gathered, including 372 males (49.3%), and 382 females (50.7%). Five groups of individuals were represented including religion scholars, physicians, medical students, allied health practitioners, and lay people. Of the five surveyed groups, four found “sickest-first” to be the most important prioritization principle in all three scenarios, and only the physicians group documented a disagreement. In the first scenario, physicians regarded “sickest-first” and “combined-criteria” to be of equal importance. In general, no differences were documented between the examined groups in comparison with lay people in the preference of options in all three scenarios; however, physicians were more likely to choose “combination” in both the second and third scenarios (OR 3.70, 95% CI 1.62–8.44, and 2.62, 95% CI 1.48–4.59; p < 0.01), and were less likely to choose “sickest-first” as the single most important prioritization principle (OR 0.57, CI 0.37–0.88, and 0.57; 95% CI 0.36–0.88; p < 0.01). Out of 100 free comments, 27 (27.0%) thought that the “social-value” of patients should also be considered, adding the 10th potential allocation principle. Our findings are concordant with literature in terms of allocating scarce medical resources. However, “social-value” appeared as an important principle that should be addressed when prioritizing scarce medical resources in Jordan.

Whom Should Be Saved? A Proposed Ethical Framework for Allocating Scarce Medical Resources to COVID-19 Patients Using Fuzzy Logic

“…Likewise, Scheidegger et al (28) had recommended that "professionals whose health is at greater risk in the event of infection with the coronavirus are to be especially protected." Based on their survey, Yousef et al (26) have highlighted that the sickest patients are recommended to be considered first for scarce medical resources allocation. Moreover, the likelihood to survive the longest is also considered a priority for scarce medical resource allocation.…”

“…Emmanuel et al (19) recommend that medical resources "should go first to front-line healthcare workers and others who care for ill patients and who keep critical infrastructure operating." Similarly, Yousef et al (26) had considered giving priority to those who have essential roles for keeping society operational or have contributed in the past to the common good.…”

“…Therefore, a combined criterion (based on more than one principle) is often more preferred. This is highlighted in a recent comprehensive study conducted in Jordan to assess general public opinions regarding allocating scarce medical resources, and physicians tend to choose combined criteria while deciding who should be given medical attention first (26). Based on that, an ethical framework that combined multiple ethical principles to prioritize medical resource allocation decisions is proposed.…”

“…Another recent study, conducted in Jordan, collected a total of 754 responses from five different public groups: religion scholars (3.9%), physicians (22.0%), medical students (21.5%), allied health practitioners (16.2%), and lay people (36.3%). The survey was based on nine ethical principles for allocating medical resources: sickest-first, waiting list (order), youngest first, service, random, monetary contribution, survival, instrumental value, and individual behavior (26). Four groups (excluding physicians) favor sickest-first despite the age, while the physicians tend to choose combined criteria when allocating the scarce medical resources (26).…”

Providing laypeople with results from dynamic infectious disease modelling studies affects their allocation preference for scarce medical resources—a factorial experiment

“…Persad et al [ 1 , 2 ] proposed guiding principles for the allocation of scarce resources: equal treatment (random selection, waiting list), utilitarianism (prognosis, number of lives saved), prioritarianism (sickest first, youngest first), and instrumental value (rewarding social usefulness in the past or in the future). Yousef et al [ 3 ] added the two principles monetary contribution to the costs of one’s own medical treatment and individual behaviour (not engaging in risky behaviours that caused one’s medical condition) to this list.…”