Overview of the four ethical principles and their practical application in the fair allocation of scarce medical resources10 13 16
| Ethical principles | Practical application | Definition | Advantages | Disadvantages |
| Utilitarianism | Save the most lives | Aims to save the most lives by offering treatment to as many individuals as possible | Benefits the greatest number of lives | |
| Prognosis or life-years | Aims to save the most life-years by prioritising those with the best prognoses | Maximises life-years gained | Strong prediction model needed | |
| Egalitarianism | Lottery | Allocation of treatment through random selection | Difficult to manipulate; easy to implement as little information is needed | |
| First-come–first-served | Allocation based on the order of request | Secures current treatments; easy to implement as little information is needed | Favours the privileged; open to corruption | |
| Social usefulness | Instrumental value | Prioritises those with skills that are useful or can be in the future | Helps promote important societal values; oriented towards the future | Vulnerable to corruption through choice of who is prioritised |
| Reciprocity | Prioritises those who have contributed to society in the past | Does justice to those who have been important for society in the past; oriented on the past | Vulnerable to corruption through choice of who is to be prioritised; undermines social solidarity | |
| Monetary contribution | Prioritises those who contribute to the costs of medical treatment16 | Reduces healthcare costs; intuitive as it reflects the principle that those who need more should pay more | Favours wealthy citizens; makes allocation to worst-off impossible; undermines social solidarity and increases inequality | |
| Individual prioritisation | Sickest first | Prioritises those who currently have the greatest need for treatment | Intuitive to healthcare system; favours the ‘worst-off’ | Ignores post-treatment prognosis; ignores those who might become seriously ill in the future if not treated |
| Youngest first | Prioritises those who have had the least life-years | Favours those who have had the least life-years and thus have the highest potential to live a long time | Prioritises infants over children and adolescents | |
| Behaviour | Prioritises those who have not behaved in such a way that it either caused their condition or negatively affected it16 | Promotes and rewards a healthy lifestyle; promotes individual responsibility16 | Ignores reasons for individual behaviour; might conflict with privacy or liberty rights |