PT  - JOURNAL ARTICLE
AU  - Munthe, Christian
AU  - Fumagalli, Davide
AU  - Malmqvist, Erik
TI  - Sustainability principle for the ethics of healthcare resource allocation
AID  - 10.1136/medethics-2020-106644
DP  - 2021 Feb 01
TA  - Journal of Medical Ethics
PG  - 90--97
VI  - 47
IP  - 2
4099  - http://jme.bmj.com/content/47/2/90.short
4100  - http://jme.bmj.com/content/47/2/90.full
SO  - J Med Ethics2021 Feb 01; 47
AB  - We propose a principle of sustainability to complement established principles used for justifying healthcare resource allocation. We argue that the application of established principles of equal treatment, need, prognosis and cost-effectiveness gives rise to what we call negative dynamics: a gradual depletion of the value possible to generate through healthcare. These principles should therefore be complemented by a sustainability principle, making the prospect of negative dynamics a further factor to consider, and possibly outweigh considerations highlighted by the other principles. We demonstrate how this principle may take different forms, and show that a commitment to sustainability is supported by considerations internal to the ethical principles already guiding healthcare resource allocation. We also consider two objections. The first of these, we argue, is either based on implausible assumptions or begs the question, whereas the second can be adequately accommodated by the principle we propose.