Background. During the COVID-19 pandemic, policymakers appeared to shift toward more efficiency-oriented medical decision making as resources became increasingly scarce. However, it remains unclear whether this shift was driven by the experience of scarcity itself or by the use of more concretely formulated ethical principles. This study investigates whether a national crisis influences public support for health care priority setting principles, and whether abstract versus concrete formulations of these principles affect that support. Design. We conducted a pre-registered online experiment (n = 1,404) to examine public attitudes toward three ethical principles formalized in the Swedish ethical platform—human dignity, needs-solidarity, and cost-effectiveness—in both crisis and non-crisis contexts. We also manipulated how the principles were presented, using either abstract or concrete formulations. Results. In the crisis condition, support for the human dignity and cost-effectiveness principles decreased, while support for the needs-solidarity principle increased. However, these effects were small, and the overall ranking of the principles remained stable. Notably, the level of abstractness had a stronger impact than the crisis context: support for needs-solidarity was higher when described abstractly, whereas support for cost-effectiveness increased when it was presented in a more concrete, action-oriented way. Support for the human dignity principle was unaffected by the abstractness manipulation. Conclusion. The findings suggest that people’s moral views are relatively stable in the face of crisis. Rather than the crisis context itself, the way ethical principles are formulated—abstractly or concretely—may be a more powerful driver of shifts in public support for different moral values in health care priority setting.

How should scarce healthcare resources be distributed? This is a contentious issue that became especially pressing during the pandemic. It is often emphasised that studies exploring public views about this question provide valuable input to the issue of healthcare priority setting. While there has been a vast number of such studies it is rarely articulated, more specifically, what the results from these studies would mean for the justification of principles for priority setting. On the one hand, it seems unreasonable that public values would straightforwardly decide the ethical question of how resources should be distributed. On the other hand, in a democratic society, it seems equally unreasonable that they would be considered irrelevant for this question. In this paper we draw on the notion of reflective equilibrium and discuss the relevance and roles that empirical studies may plausibly have for justification in priority setting ethics. We develop a framework for analysing how different kinds of empirical results may have different kinds of implications for justification.

Post COVID-19 Condition (PCC) is a complex condition presenting significant challenges for patients. Individuals suffering from severe PCC are often assessed in rehabilitation medicine departments or specialized post-COVID centres, where their condition is evaluated using the International Classification of Functioning, Disability and Health (ICF). The ICF framework primarily focuses on functional impairments, disabilities, and restrictions in participation, with an emphasis on the concept of “functioning.” However, a critical question remains: how does this notion of functioning relate to the well-being of these individuals? This paper explores this issue by examining three fictionalized but typical case studies of PCC patients in relation to two distinct theoretical approaches. First, we engage with theories about well-being from the philosophy of well-being emphasizing the individual’s perspective. Second, we explore relational approaches in bioethics and their theoretical underpinnings, which emphasize how people are situated, considering context and relations rather than purely individual conditions. The paper highlights the potential tensions between these approaches while arguing that a more comprehensive understanding of well-being can emerge by integrating insights from both traditions. Through the examination of PCC patient cases, we propose that well-being can be better understood when approached from multiple angles, enriching the understanding of patient outcomes in rehabilitation medicine. 

In this article we discuss some ethically and legally controversial issues in the Swedish priority guidelines for intensive care during the recent covid pandemic. We show how the Swedish ethics platform for priority setting constitutes a robust starting point for such guidance, but that there is a lack of detail leaving some of the more challenging situations without explicit guidance. To provide guidance, which we have reason to do in order to avoid inequality and arbitrariness, we should try to interpret the ethics platform, based on how it is applied in practice together with ethical reasoning. In this article, we illustrate this by focusing on contested guidance concerning biological age when distributing scarce intensive care beds. We conclude that biological age should be interpreted in terms of long-term survival. We also conclude that the ethical platform does not provide guidance in these challenging situations, but needs interpretation. Therefore, there is a need of a legal overview of the principles in order to create an even stronger basis for support in the future

When considering the introduction of a new intervention in a budget constrained healthcare system, priority setting based on fair principles is fundamental. In many jurisdictions, a multi-criteria approach with several different considerations is employed, including severity and cost-effectiveness. Such multi-criteria approaches raise questions about how to balance different considerations against each other, and how to understand the logical or normative relations between them. For example, some jurisdictions make explicit reference to a large patient benefit as such a consideration. However, since patient benefit is part of a cost-effectiveness assessment it is not clear how to balance considerations of greater patient benefit against considerations of severity and cost-effectiveness. The aim of this paper is to explore the role of a large patient benefit as an independent criterion for priority setting in a healthcare system also considering severity and cost-effectiveness. By taking the opportunity cost of new interventions (i.e., the health forgone in patients already receiving treatment) into account, we argue that patient benefit has a complex relationship to priority setting. More specifically, it cannot be reasonably concluded that large patient benefits should be given priority if severity, cost-effectiveness, and opportunity costs are held constant. Since we cannot find general support for taking patient benefit into account as an independent criterion from any of the most discussed theories about distributive justice: utilitarianism, prioritarianism, telic egalitarianism and sufficientarianism, it is reasonable to avoid doing so. Hence, given the complexity of the role of patient benefit, we conclude that in priority practice, a large patient benefit should not be considered as an independent criterion, on top of considerations of severity and cost-effectiveness.

This paper focuses on medical neutrality as impartiality as a ground for rationing medical care in the context of armed conflict. Impartiality is often taken to entail that medical professionals should not discriminate between patients on “morally irrelevant grounds”. Common examples of such grounds are age, gender, nationality, and political affiliation. This, in turn, is an idea akin to a principle of formal justice. Accordingly, medical neutrality as impartiality says something about how medical care should be distributed in armed conflict, or more specifically, it specifies grounds on which such care should not be distributed. However, it is unclear what this implies for rationing more specifically. The aim of this paper is to explore the concept of medical neutrality as impartiality, more specifically, to spell out the implications of medical neutrality as impartiality for the distribution of medical care in armed conflict. The paper argues that medical neutrality as impartiality must be understood as a mid-level ethical principle, rather than a high-level principle, to be applicable in practice. However, when ideas about formal justice are taken from high-level ethical theory and are applied on a mid-level, several questions arise. The paper then discusses two such questions.