Dear Colleagues,

The COVID-19 pandemic has brought our attention back to the management and equitable distribution of limited health resources. Initially, the debate focused on intensive care beds and the availability of respirators. Later, the focus shifted to access to vaccines.

The intent of this issue is not so much to reflect on what happened during the pandemic, but to look to the future: What can we learn from the pandemic. Are we better prepared to face other similar challenges in the future? Have we found values or principles that could guide us in equally difficult choices in the future? Would the ethical principles that have guided us in this pandemic work in the future?

The criteria used for access to intensive care were different from those used for vaccines. In the case of vaccines, priority was given to the elderly, whereas in intensive care, the elderly had no priority. Essentially, suggestions were made to give priority to young people when it came to allocating ICU beds. Our question is, should age be used as an allocation criterion in the future, and in what sense? Would it be ethical and cost-effective, and could it be evaluated objectively? Would it achieve the greatest good for the greatest number? Or, is using age as a criterion always an instance of ageism and unfair discrimination?

Almost all countries started their vaccination programs with the elderly. The rationale was that they were the most vulnerable and most likely to die from coronavirus. However, what if a future threat would be equally dangerous across the age groups? Should we still prioritize, and if we should, on what criteria? Should we give priority to the young, so that they would have a better chance of reaching a normal life expectancy? Or should we prioritize those with reproductive capabilities to secure the continuation of the human race? Or perhaps we should start with the essential workers and those whose contributions keep the basic functions of the society running?

A further problem is the bedside decision making: "who decides the triage?". In the COVID-19 pandemic, two competing models have been suggested. Some preferred external committees deciding the ICU bed allocation, whereas others thought that this reduces doctors to technicians and would prefer doctors as decision makers. Both models have their advantages and disadvantages and need to be studied further.

An extension of the bedside triage problem is the decision making on a national and perhaps even international level. Who should make the public health policy decisions that affect everyone’s lives? In democracies, the elected representatives of the public should surely have their say, but given that public health crises are beyond their expertise, other players need to be included as well. If the COVID-19 pandemic has taught us anything, it is that we are not well prepared to respond to crises of this sort in efficient ways. Procedures to aptly respond to future crises, that can be initiated at a very short notice, should be put in place. Their shape and form need to be carefully considered.

An additional problem is to understand what is the different value of the guidelines that are proposed to doctors. Some guidelines are created by scientific societies, sometimes composed only of doctors. Other guidelines are developed by ethics committees that have interdisciplinary expertise within them. Further guidelines are issued by elected governments or supranational legal entities. What relationship can or should there be between these different guidelines?

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but not limited to) the following: 

• Allocation of health resources and theories of justice;
• Criteria for allocation of life-saving resources;
• Conflicts to secure limited resources and their management;
• Rationing of health resources in emergency conditions;
• Decision making under scarcity;
• Inequalities in health and well-being;
• The philosophical discussion on the age criterion for the selection of patients;
• Age discrimination in healthcare;
• Clinical ethics at the test of pandemics;
• Ethics committees as a resource during emergencies;
• Informed consent during pandemics and in emergency situations;
• The problem of trust in scientific and health authorities;
• The relationship between doctors’ responsibilities and guidelines in extraordinary situations. 

I look forward to receiving your contributions.

Prof. Dr. Fabrizio Turoldo
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a double-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Philosophies is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.