Abstract
We describe ethical issues arising in the allocation of civilian medical resources during armed conflict. Three features are significant in the context of allocating scarce resources in armed conflicts: the distinction between continuous and binary medical resources; the risks of armed conflict itself, and the impact of cultural differences on cases of armed conflict. We use these factors to elicit a modified principle for allocating medical resources during armed conflict, using hemodialysis for patients with end-stage renal disease as a case study.
Highlights
Armed conflict jeopardizes patient care, inter alia, through shortages in vital medical supplies
When supplies are radically insecure, providing a level of care ensures continued supply of resources for patients until replacement occurs. This consideration will need to be balanced against other considerations: if differential increases in some patient dosages frees up a scarce resource—if, for example, a high dose of a life saving drug given to some patients will free up beds in an overloaded hospital it may be, all other things being equal, justified to give small number of patients higher doses of a scarce drug to benefit a large set of other patients
In light of the above considerations of resource modalities, the risks of armed conflict, and culture, we offer the following principles for allocating hemodialysis sessions
Summary
Armed conflict jeopardizes patient care, inter alia, through shortages in vital medical supplies. When supplies are radically insecure, providing a level of care ensures continued supply of resources for patients until replacement occurs This consideration will need to be balanced against other considerations: if differential increases in some patient dosages frees up a scarce resource—if, for example, a high dose of a life saving drug given to some patients will free up beds in an overloaded hospital it may be, all other things being equal, justified to give small number of patients higher doses of a scarce drug to benefit a large set of other patients. In times of extreme scarcity and insecurity, scarce medical resources should be allocated in a way that maximizes the length of time a patient population can continue to receive clinically meaningful care. Providing guidance to patients to reduce time in care facilities, where communication infrastructure is not so broken as to make such communication counterproductive [17], will help maintain supplies for a community and protect patients against a range of risks beyond those of their care
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