Balancing speed and equity in the rollout of COVID-19 vaccines

By Maxwell J. Smith COVID-19 vaccines are in limited supply, and so it’s crucial that their harm-reducing powers are deployed strategically. This likely requires two things: (1) prioritizing vaccines to those at greatest risk of mortality, hospitalization, transmission, and/or infection; and (2) administering vaccinations as rapidly as possible. Yet, it is sometimes not possible to […]

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Paying more for highly specialised technologies: equity or profligacy?

By Jonathan Michaels The National Institute for Health and Care Excellence (NICE) recently consulted on possible revisions to its processes for health technology evaluation.  An important aspect of the proposed changes related to topic selection criteria for the Highly Specialised Technologies (HST) programme.  This is of great commercial interest as it allows some technologies to […]

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When the going gets tough, where do persons with disabilities stand? Covid-19 pandemic, community-centered medicine and scarce health resources allocation

By Nicola Panocchia, Viola D’Ambrosio, Serafino Corti, Eluisa Lo Presti, Marco Bertelli, Maria Luisa Scattoni, and Filippo Ghelma The COVID-19 pandemic led to a shift in the medical paradigm from person-centered medicine to community-centered medicine. This shift gives “priority to community health above that of the individual patient in allocating scarce resources”. The patient-physician relationship […]

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Valuing the care in healthcare: priorities and trade-offs

By Jonathan Michaels. Healthcare decisions are complex, whether we are considering individual choices about our own health, or policy decisions made by political or professional bodies.  Disease and the actions taken to prevent, diagnose and treat it, may have widespread ramifications on all aspects of our lives.  Furthermore, policy and personal decisions in other aspects […]

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You’ve got to be in it to win it: The promise and practice of vaccine lotteries

By Jane Williams, Chris Degeling, Angus Dawson, Stacy Carter Following the 2009 H1N1 pandemic there was a small explosion in the ethics literature on how to allocate scarce pandemic vaccine. There were many different suggestions about how we should distribute vaccine in an ethical way. One proposal was that a random allocation through a lottery, weighted […]

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NICE’s wrong turns: opportunity costs and missed opportunities

By Jonathan Michaels. The National Institute for Health and Care Excellence (NICE) is consulting on its methods for health technology evaluation, seeking ‘public’ views on over two thousand pages of highly technical supporting material.  NICE was established to promote “clinical and cost-effectiveness through guidance and audit” and address ‘postcode prescribing’ and has led the world […]

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Healthcare must stop ignoring future patients!

By Christian Munthe, Davide Fumagalli and Erik Malmqvist Most countries with publicly funded healthcare systems have ethically informed priority setting schemes to decide how to allocate scarce resources. Established principles in such schemes recognise patients’ need of care, the effects of interventions, and background requirements of equal consideration and cost-effectiveness. However, the typical use of […]

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Vaccine distribution ethics: monotheism or polytheism?

By Alberto Giubilini, Julian Savulescu and Dominic Wilkinson. Pfizer has reported preliminary results that their mRNA COVID vaccine is 90% effective during phase III trials. The hope is to have the first doses available for distribution by the end of the year. Discussion has quickly moved to how the vaccine should be distributed in the […]

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Prioritizing trust and consistency when allocating ventilators

By Alexander T.M. Cheung and Brendan Parent Rationing healthcare resources never sits well with all parties involved. By definition, someone gets left out. Various values, contrary perspectives, and practical considerations all must be weighed before reaching a morally passable, though imperfect, compromise. Yet never has the question of rationing so acutely needed answering in the […]

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Ethical decision making when demand for intensive care exceeds available resources. The need for public discussion.

By Tim Cook, Kim J Gupta, Robin Fackrell, Sarah Wexler, Bernie Marden Early in the COVID-19 pandemic the first author of this blog wrote a Guardian article which was titled “ICU doctors now face the toughest decisions they will ever have to make.” It referred to the possibility – then expected to be a reality […]

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