This article discusses challenging resource allocation decisions in Italy in response to COVID-19 from the perspective of medical ethics.

Italy has experienced the largest COVID-19 outbreak in Europe, with the country’s northern region particularly severely affected. Due to the limited supply of ventilators, case surge in northern Italy has required application of prioritization criteria to allocate scarce resources among patients in need of critical care. While the article notes that these decisions are currently being precipitated by an extraordinary emergency, the author argues that the rationing of scarce resources is common in the recent history of medicine. The author cites initial scarcity of dialysis beds and ongoing allocation of transplantable organs as examples of prioritization criteria being applied to life-sustaining care that leaves some without when demand exceeds supply.

The article does, however, argue that the current crisis is unusual in that the outbreak affects an extraordinarily high number of people, meaning that prioritization may apply across an entire population, rather than a smaller, finite group, such as those awaiting organ transplants. This can be difficult to reconcile in a high-income country where persons are accustomed to a right to accessing health care services and being offered the best available care. The principle of justice states that equals should be treated equally and all lives should be treated as equally valuable, and the author argues that in the case of allocating scarce resources this is consistent with prioritizing resources in ways that are more likely to save the most lives.