A theory of triage.

This paper provides a general framework for conceptualizing triage for intensive care unit admissions in public health emergencies such as the COVID-19 pandemic. It applies this framework to some of the guidelines issued during the pandemic and addresses some controversial issues, including the role of age, the use of lives or life years, and the relevance of quality of life considerations. The paper defends a view on which triage protocols for public health emergencies should aim to maximize the number of life years saved, may take into account age as a proxy, and should ignore quality of life considerations.

Rethinking patient involvement in healthcare priority setting.

With healthcare systems under pressure from scarcity of resources and ever-increasing demand for services, difficult priority setting choices need to be made. At the same time, increased attention to patient involvement in a wide range of settings has given rise to the idea that those who are eventually affected by priority setting decisions should have a say in those decisions. In this paper, we investigate arguments for the inclusion of patient representatives in priority setting bodies at the policy level.

The Mismarriage of Personal Responsibility and Health.

This paper begins with a simple illustration of the choice between individual and population strategies in population health policy. It describes the traditional approach on which the choice is to be made on the relative merits of the two strategies in each case. It continues by identifying two factors-our knowledge of the consequences of the epidemiological transition and the prevalence of responsibility-sensitive theories of distributive justice-that may distort our moral intuitions when we deliberate about the choice of appropriate risk-management strategies in population health.

Fair innings.

In many societies, the aging of the population is becoming a major problem. This raises difficult issues for ethics and public policy. On what is known as the fair innings view, it is not impermissible to give lower priority to policies that primarily benefit the elderly.

Impartiality and disability discrimination.

Cost-effectiveness analysis is the standard analytical tool for evaluating the aggregate health benefits of treatments and health programs. According to a common objection, however, its use may lead to unfair discrimination against people with disabilities. Since the disability discrimination objection is seldom articulated in a precise way, I first provide a formulation that avoids some implausible implications.

Complete lives in the balance.

The allocation of scarce health care resources such as flu treatment or organs for transplant presents stark problems of distributive justice. Persad, Wertheimer, and Emanuel have recently proposed a novel system for such allocation. Their "complete lives system" incorporates several principles, including ones that prescribe saving the most lives, preserving the most life-years, and giving priority to persons between 15 and 40 years old.

Well-being and health.

One way of evaluating health is in terms of its impact on well-being. It has been shown, however, that evaluating health this way runs into difficulties, since health and other aspects of well-being are not separable. At the same time, the practical implications of the inseparability problem remain unclear.