The Health Services Research Unit - HØKH, Akershus Universitetssykehus HF, Lorenskog, Norway
Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway.
J Med Ethics. 2024 May 9;50(5):320-323. doi: 10.1136/jme-2023-108972.
Fair priority setting is based on morally sound criteria. Still, there will be cases when these criteria, our primary considerations, are tied and therefore do not help us in choosing one allocation over another. It is sometimes suggested that such cases can be handled by tiebreakers. In this paper, we discuss two versions of tiebreakers suggested in the literature. One version is to preserve fairness or impartiality by holding a lottery. The other version is to allow secondary considerations, considerations that are not part of our primary priority setting criteria, to be decisive. We argue that the argument for preserving impartiality by holding a lottery is sound, while the argument for using tiebreakers as secondary considerations is not. Finally, we argue that the instances where a tiebreaker seems necessary are precisely the situations where we have strong reasons for preferring a lottery. We conclude that factors that we consider valuable should all be included among the primary considerations, while ties should be settled by lotteries.
公平的优先级设置基于道德合理的标准。然而，仍会有一些情况，这些标准，即我们的主要考虑因素，是相互关联的，因此无法帮助我们在一种分配与另一种分配之间做出选择。有人认为，这种情况下可以使用决胜局来处理。在本文中，我们讨论了文献中提出的两种决胜局版本。一种版本是通过抽签来保持公平或公正。另一种版本是允许次要考虑因素，即不属于我们主要优先级设置标准的因素，具有决定性。我们认为，通过抽签来保持公正性的论点是合理的，而将决胜局作为次要考虑因素的论点则不合理。最后，我们认为，决胜局似乎是必要的情况恰恰是我们有强烈理由偏爱抽签的情况。我们的结论是，我们认为有价值的因素都应该包括在主要考虑因素中，而平局应该通过抽签来解决。
