An ethical algorithm for rationing life sustaining treatment during the COVID-19 pandemic

The burning ethical question raised by the COVID-19 pandemic is how to deal fairly andethically with a large number of patients simultaneously becoming critically unwell. Acrossthe world, in both developed and developing countries, health systems are grappling withthe possibility or the reality that the demand for intensive medical care will outstripavailability. There is a need for ethical guidelines on how to allocate treatment, but suchguidelines are potentially highly controversial.1 In this commentary, we set out a simplealgorithm (Figure 1), including what we take to be the essential ethical principles that oughtto guide resource allocation in any country or setting as well as optional elements that willvary between countries depending on the weight placed on different ethical values (Table1).