Ethical allocation of resources in paediatrics — viva

Stem

Examiner-led viva on a surge and a cost-based allocation scenario. ^[3]

Examiner: Two children need the last PICU bed. On what principle do you frame the decision? ^[1]

Strong answer: I frame it on distributive justice, because the question is fair distribution of a scarce resource across the population, not the best interests of one child. I then operationalise it with the four allocation principles from Persad, Wertheimer and Emanuel — maximise benefits, treat people equally, prioritise the worst off, and recognise instrumental value — and I ground the decision in accountability for reasonableness. ^[1]

Examiner: Name the conditions of accountability for reasonableness. ^[2]

Strong answer: Publicity, so the criteria are open; relevance, so they are relevant to stakeholders; appeals, so there is a revision and appeal pathway; and enforcement, so the process is actually followed and improved. The point is that a community can accept a painful outcome if it can see how the decision was made. ^[2]

Examiner: How do you classify this scarcity, and what does that mean for who decides? ^[3]

Strong answer: This is absolute scarcity — demand exceeds any conceivable supply — so the defensible step is to invoke the pre-agreed paediatric-aware triage protocol and separate the triage officer from the treating team. If this had been a cost-based scarcity, such as the gene therapy, the locus would be the macro-level funding body using explicit criteria, not the bedside clinician. ^{[3] [6]}