Who Gets the Ventilator? Moral Decision Making Regarding Medical Resource Allocation in a Pandemic

As the COVID-19 pandemic increases the number of critically ill patients flowing into hospitals, hospitals in many countries are facing a growing shortage of vital equipment and supplies, presenting ethical dilemmas to physicians who have to decide which COVID-19 patients to prioritize when resources are scarce. Using over 75,000 hypothetical decisions collected from over 5,000 people across 11 countries accounting for over 69% of all COVID-19 cases reported worldwide, we explore lay people’s preferences of how scarce medical resources should be allocated in the time of the COVID-19 pandemic. We first examine the global ethical preferences in medical resource allocation decisions as well as cross-country differences. We then document individual variations in these preferences. Our findings suggest that people have the strongest preferences for saving young (vs. old) patients and saving patients that are more likely to survive, indicating that lay people consider maximizing total benefits as the most important ethical rule when allocating scarce medical resources in the COVID-19 pandemic. Country-level differences in cultural dimensions (e.g., individualism-collectivism) and economic development (e.g., GDP per capita) contribute to cross-country differences in weights attached to various patient characteristics. Individual characteristics (e.g., gender, age, religiosity) and the severity of the local pandemic also have an impact on people’s ethical preferences.