Case 3. Allocating Scarce Resources in a Medical Crisis

1. What is the clinical situation?

During a large-scale public health crisis, a hospital faces a severe shortage of critical care resources such as ICU beds and ventilators. Multiple patients arrive in respiratory failure, all of whom would likely benefit from intensive care. However, there are not enough resources to treat everyone simultaneously. Physicians must decide which patients receive life-sustaining treatment and which do not, often under extreme time pressure.

Institutional guidelines may exist, but they cannot account for every clinical detail or personal circumstance. The decisions must be made quickly, with incomplete information, and under emotionally charged conditions.

2. What are the ethical issues?

This case raises a profound ethical tension between fairness and maximizing benefit. Physicians must consider whether to prioritize patients based on likelihood of survival, length of expected benefit, age, comorbidities, or order of arrival. The ethical question is whether treating those with the highest chance of survival is more justifiable than treating patients equally.

The case also raises concerns about implicit bias, discrimination, and whether resource allocation decisions risk valuing some lives more than others.

3. Who is affected?

Patients are directly affected, as these decisions may determine survival. Families experience distress when care is delayed or denied. Physicians are deeply affected as moral agents tasked with making decisions that carry life-and-death consequences. Healthcare institutions and society are also affected, as these cases shape public trust in the medical system and expectations of fairness during crises.

4. What options exist?

Physicians may allocate resources on a first-come, first-served basis. They may prioritize patients with the highest likelihood of survival or those expected to benefit most from treatment. Alternatively, decisions may follow institutional triage protocols designed to guide allocation during emergencies. Each option attempts to balance fairness, effectiveness, and moral responsibility, yet none eliminates ethical distress.

5. What decision is ethically justifiable?

Using transparent and consistently applied triage criteria that aim to maximize benefit while minimizing bias can be ethically justifiable during resource scarcity. Although denying care is deeply troubling, ethical responsibility may require physicians to make decisions that serve the greatest number of patients rather than individual preference. In such cases, the physician’s role is to act fairly, consistently, and honestly, while acknowledging the moral weight of these decisions.

Reflection

This case highlights that ethical medical decisions extend beyond individual patient care and into responsibilities toward society. It demonstrates that fairness does not always mean treating everyone the same, and that physicians must sometimes make decisions that conflict with their instinct to help every patient. For future physicians, this case underscores the importance of ethical clarity, transparency, and humility when medicine’s resources are limited.