This article reports on the development of two sets of ethical allocation guidelines in Australia for a public health emergency in which resources must be rationed.

One approach, led by bioethicist Angus Dawson, rejects the use of strict allocation formulas in favor of a form of lottery system in which each patient has an equal chance of being allocated a given the resource, such as an ICU bed. While a random allocation system may be perceived as fair, it carries the risk that scarce resources may not be used in the most efficient way possible. Hospitals could also choose to prioritize some categories of patients, including health care workers, younger patients, pregnant women, parents and other caregivers, and First Nations communities. However, other characteristics, such as gender, ethnicity, disability, or age should not be considered.

The other approach, developed by bioethicists Wendy Rogers and Stacy Carter, also uses a lottery system, but only as a secondary approach to differentiate between patients who are otherwise equally eligible for a resource on the basis of their condition. Hospitals could choose to prioritize the most critically ill, the most disadvantaged, or the patients most likely to benefit from treatment.

Key points of both frameworks, as well as those developed in other countries, include that patients who are not allocated scarce resources should never be abandoned and should receive palliative care to treat pain and other symptoms to the extent possible. Additionally, allocation decisions should not be made by bedside treatment or care teams, but rather by separate, unbiased triage officials or teams applying clear protocols that are publicized, consistent, accountable, evidence-based, and open to appeal.