Awad, Edmond, Bago, Bence, Bonnefon, Jean-François, Christakis, Nicholas, Rahwan, Iyad and Shariff, Azim (2022) Polarized Citizen Preferences for the Ethical Allocation of Scarce Medical Resources in 20 Countries. MDM Policy & Practice, vol. 7 (N° 2). pp. 1-9.

Abstract

Objective. When medical resources are scarce, clinicians must make difficult triage decisions. When these decisions
affect public trust and morale, as was the case during the COVID-19 pandemic, experts will benefit from knowing
which triage metrics have citizen support. Design. We conducted an online survey in 20 countries, comparing support
for 5 common metrics (prognosis, age, quality of life, past and future contribution as a health care worker) to a
benchmark consisting of support for 2 no-triage mechanisms (first-come-first-served and random allocation).
Results. We surveyed nationally representative samples of 1000 citizens in each of Brazil, France, Japan, and the
United States and also self-selected samples from 20 countries (total N = 7599) obtained through a citizen science
website (the Moral Machine). We computed the support for each metric by comparing its usability to the usability of
the 2 no-triage mechanisms. We further analyzed the polarizing nature of each metric by considering its usability
among participants who had a preference for no triage. In all countries, preferences were polarized, with the 2 largest
groups preferring either no triage or extensive triage using all metrics. Prognosis was the least controversial metric.
There was little support for giving priority to healthcare workers. Conclusions. It will be difficult to define triage
guidelines that elicit public trust and approval. Given the importance of prognosis in triage protocols, it is reassuring
that it is the least controversial metric. Experts will need to prepare strong arguments for other metrics if they wish
to preserve public trust and morale during health crises.