An ethical algorithm for rationing life sustaining treatment during the COVID-19 pandemic

The burning ethical question raised by the COVID-19 pandemic is how to deal fairly and ethically with a large number of patients simultaneously becoming critically unwell. Across the world, in both developed and developing countries, health systems are grappling with the possibility or the reality that the demand for intensive medical care will outstrip availability. There is a need for ethical guidelines on how to allocate treatment, but such guidelines are potentially highly controversial.1 In this commentary, we set out a simple algorithm (Figure 1), including what we take to be the essential ethical principles that ought to guide resource allocation in any country or setting as well as optional elements that will vary between countries depending on the weight placed on different ethical values (Table 1).