Table 1

Summary of findings

ArticleCommunityLanguage used in the study*Ethical principles†Community preferences
Department of Health - Seattle & King County, 2009123 adults
(Seattle, Washington, USA)
‘Hospitals should take into account the likelihood of the patient surviving to avoid using scarce resources on patients who are less likely to survive, even with treatment’.Save the most lives.(General preferences)
After community forum participation (% agree to use):
84%—Save the most lives.
47%—Save the most life-years.
14%—First come, first served.
65%—Quality of life.
‘Hospitals should take into account the number of years a person would live if they survive when deciding who should get scarce resources’.Save the most life-years.
‘Hospitals should provide lifesaving care on a first come, first served basis regardless of other considerations’.First come, first served.
‘Hospitals should take into account the quality of life a person would have if they survive when deciding who should get scarce resources’.Quality of life.
Bailey et al, 2011185225 students, staff and faculty
(University of Alberta, Canada)
‘Save the most lives possible, irrespective of differences’.Save the most lives.(General preferences)
Participants chose one:
39.9%—Save the most lives.
22.4%—Priority group rank.
20.4%—Help the worst off.
9.9%—Save the most life-years.
4.5%—Children first.
2%—Women and children first.
1%—First come, first served.
‘Save people according to a priority group ranking system (age groups, healthcare workers, politicians)’.Priority group rank.
‘Save those most likely to die if not treated’.Help the worst off.
‘Save that group of people that will have that most years of life to live because of treatment’.Save the most life-years.
‘First come, first served’.First come, first served.
‘Save children first’.Children first.
‘Save women and children first’.Women and children first.
Biddison et al, 2014868 adults
(Maryland, USA)‡
‘First-come-first-served’.First come, first served.Always or often use in guidelines (% agree):
Older participants: save the most lives (83%).
Younger participants: save the most lives (33%).
White participants: save the most lives (83%).
Black participants: save the most lives (33%).
High income: save the most lives (83%).
Low income: save the most lives (33%).
‘Lottery’.Lottery.
‘Prioritize those most likely to survive’.Save the most lives.
‘Prioritize those with the most years left (survive the most number of years, underlying illnesses the patient already has are considered)’.Save the most life-years.
‘Life cycle of ‘fair innings’ principle’.Life cycle.
‘Value to others in a pandemic’.Instrumental value.
Biddison et al, 201814228 adults
(Maryland, USA)
‘Prioritize those most likely to survive the current illness’.Save the most lives.Always or often use in guidelines (% agree):
Increasing age was a significant predictor of objecting to use of a lottery (OR 1.03; 95% CI 1.02 to 1.04).
African Americans had lower odds of preferring ‘save the most life years’ (OR 0.34; 95% CI 0.21 to 0.58) and higher odds of preferring ‘first come, first served’ (OR 2.36; 95% CI 1.29 to 4.29).
‘Prioritize those most likely to live the longest after recovery (considering comorbid conditions)’.Save the most life-years.
‘Prioritize those who have lived fewer life stages’.Life cycle.
‘Prioritize those who have particular instrumental value to others in the pandemic’.Instrumental value.
‘First come, first served’.First come, first served.
‘Lottery’.Lottery.
Schoch-Spana et al, 20201630 adults
(Texas, USA)
‘Survive current illness’.Save the most lives.(General preferences)
Always or often use in guidelines (% agree):
86.7%—Save the most lives.
50%—Save the most life-years.
40%—Instrumental value.
33%—Life cycle.
‘Survive longest’.Save the most life-years.
‘Fewest life stages’.Life cycle.
‘Value to others’.Instrumental value.
‘First come, first served’.First come, first served.
‘Lottery’.Lottery.
Pew Research Center 2020154917 adults
(USA)§
‘to patients who are most at need in the moment, which may mean fewer people overall survive, but doctors do not deny treatment based on age or health status’.Help the worst off.Participants chose one:
Under 30 save the most lives (58%), 30–49 divided, over 50 help the worst off (57%).
White divided (48%/47%), Hispanic divided (50%/45%), black help the worst off (60%).
Upper income save the most lives (52%), mid-income divided (49%/47%), low income help the worst off (56%).
‘patients who are most likely to recover with treatment, which may mean more people survive, but that some patients don’t receive treatment because they are older or sicker’.Save the most lives.
  • *Wording of concepts as presented to study respondents.

  • †Operant underlying ethical principle, standardised for purposes of comparison as not always stated verbatim as this wording.

  • ‡The study conceptualised economically advantaged population from one county with a median income of $105 692 and 4.5% of families living below the federal poverty line; and economically disadvantaged population from another county with a median income of $18 522 and 28% of families living below the federal poverty line. Conceptualised older population from one county with a mean age of 55 years and younger population from another county with a mean age of 50 years.

  • §The study conceptualised low income as <$40 100 annual income and upper income as >$120 400 annual income.