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date: 30 June 2022

Abstract and Keywords

Public healthcare systems face challenging questions about how to allocate limited medical resources. Which patients should receive treatment? Could it be ethical to ration treatment on the basis of a preexisting disability? This chapter focuses on newborn infants and uses as an example one highly intensive and costly treatment—extracorporeal membrane oxygenation (ECMO). It distinguishes treatment-level from patient-level prioritization. Triage decisions (where two or more patients present simultaneously) are compared with threshold decisions (a determination for a single patient that treatment is worth providing). A central ethical question raised by patient-level prioritization is whether it is possible to balance fairness with benefit. The chapter describes one way of balancing principles through the concept of parity and explores ways to develop practically applicable parity thresholds. It is argued that disabled patients with a predicted benefit of treatment above the parity threshold should receive equal access to treatments like ECMO.

Keywords: disability, rationing, newborn infants, intensive care, prioritization, fairness, ethics

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