Americans prefer fairness in the allocation of scarce medical resources in the fight against COVID-19, Mason research shows

News of possible COVID-19 vaccines is reason for optimism, but ethical and policy debates over the allocation of scarce medical resources during a global pandemic are still ongoing.

George Mason University professor Andrew H. Peterson and incoming Mason professor Wesley Buckwalter, both members of the Department of Philosophy within Mason’s College of Humanities and Social Sciences, surveyed more than 1,800 U.S. residents about public attitudes toward the allocation of medical resources, such as ventilators, intensive care unit (ICU) beds, hospital masks, and medical personnel. They found Americans to be more inclined to revising allocation frameworks in the interest of fairness toward marginalized and at-risk groups, even if this results in more deaths. 

The survey findings on scarce medical resources come as cases continue to spike nationally. Record-high numbers of hospitalizations are already being seen as the virus spreads. Public health experts predict that those stark numbers will increase following Thanksgiving, putting the entire health care system at a possible breaking point, and making the rationing of health care inevitable. 

The survey, which was published in the scientific journal PLOS ONE, was conducted between April and May 2020, when the COVID-19 death toll in the country had just reached 100,000. 

“We found that participants agreed with allocation motivated by utilitarian principles and prioritizing the worst-off during initial distribution of resources and disagreed with allocation motivated by egalitarian and social usefulness principles,” the two authors wrote. 

The coronavirus has been responsible for the deaths of more than 260,000 Americans and 1.3 million people globally. News that possible vaccines are on the way is also certain to exacerbate the ethical debate. Vaccine dosages are likely to be available in limited quantities in 2021. Deciding who receives one first could be a life-or-death decision. 

Peterson, a specialist in bioethics, said he is hopeful that the research will contribute to future triage policies and increase public trust in health systems while assisting physicians in helping patients during the COVID-19 pandemic. Ethicists and policy experts have been debating these issues since early 2020, but the survey now provides preliminary information about how average Americans will react to difficult triage decisions. 

“It was information we really didn’t have when the pandemic began,” he said. “Now we’re seeing what Americans think about triage. In many cases, Americans agree with the experts. But there are some important issues where they disagree.” 

Current triage policies aim at saving as many lives as possible. The severity of a patient’s condition, age, and other factors may be taken into consideration during admission to the ICU. 

In principle, Peterson said, triage policies should treat patients fairly upon admission. But it’s critical to recognize the unequal playing fields between different groups prior to their arrival. 

People of color have been hit hardest by the virus because they typically lack access to quality health care and are far more often employed in frontline jobs that greatly increase their chances of contracting COVID-19. These social determinants of health can place people of color at a disadvantage in the receipt of ICU resources. 

“Understanding public attitudes toward triage, and reacting appropriately to those attitudes could help provide legitimacy to a process that is often obscured by bureaucracy and that, without proper oversight, could have discriminatory consequences,” Peterson and Buckwalter wrote in an NBC Op-Ed

Peterson stressed that allocation of scarce medical resources in the ICU is different than allocating vaccines, but similar questions arise about fairness and public perception.  

“Which principles should guide the allocation of vaccines?” Peterson queried. “Who should get them first? How should government agencies make those decisions? And what will Americans think?”  

The Centers for Disease Control and Prevention (CDC) will ultimately decide who gets the vaccines first. An emergency meeting on the first phase of allocation is scheduled for early December, coinciding with the U.S. Food and Drug Administration’s public meeting to authorize use of Pfizer’s vaccine. High-risk health care workers are likely to be first in line, with other vulnerable groups and essential workers to be at the top of the list. 

The ethical principles examined by Buckwalter and Peterson will be at the center of these decisions.