Navigating Ethical Dilemmas in High-Stakes Resource Allocation

Abstract

The allocation of scarce resources in healthcare, especially during crises like the COVID-19 pandemic, presents complex ethical dilemmas. This study aims to explore these dilemmas through the perspectives of healthcare professionals, policymakers, and ethics experts to better understand the underlying principles and challenges that influence ethical decision-making in high-stakes resource allocation. This qualitative study utilized semi-structured interviews with 20 participants, including healthcare professionals, policymakers, and ethics experts involved in resource allocation. Data were collected until theoretical saturation was achieved and analyzed using thematic analysis to identify key themes and concepts related to ethical dilemmas in resource allocation. Four main themes were identified: Justice and Fairness, Stakeholder Perspectives, Resource Constraints, and Ethical Decision-Making Models. Each theme encompassed various categories with specific concepts: Equity in Access, Prioritization Principles, Transparency, Decision-Maker Challenges, Ethical Conflict Resolution, Patient and Public Involvement, Allocation Efficiency, Sustainability, Framework Utilization, Adaptation and Flexibility, Dilemma Specificity, and Implementation Challenges. These themes highlight the complexity of ethical decision-making and the variety of factors that must be considered. The study reveals that ethical decision-making in resource allocation is influenced by a complex interplay of fairness, stakeholder perspectives, resource limitations, and the application of various ethical frameworks. It underscores the need for adaptable, transparent, and inclusive policies that can address the nuanced challenges posed by crises in healthcare settings.