Who shall live and who shall die? A factorial survey experiment on prioritizing COVID-19 patients under medical triage conditions

During the 2020 COVID-19 pandemic expert commissions developed ethical guidelines for prioritizing assistance in the event of insufficient resources (triage). However, ethical principles may deviate from laypeople′s moral standards. Our study aims to investigate which factors help laypeople justify for prioritizing a COVID-19 patient and which respondent characteristics–among them for the first time also values–moderate their impact on prioritizing decisions. The results of a factorial survey experiment conducted in Spain 2022 showed that the most important factors were the vaccination status and the smoking behavior of patients, contradicting ethical guidelines and revealing the need for better communication between experts and the public. Better communication also means incorporating laypeople’s moral views in the process of developing ethical guidelines. Moreover, patients′ family obligations, patients′ origin, age, and social class were analyzed. Our results show that some of these factors depend on respondents’ personal values (Schwartz values), vaccination context, and smoking behaviors.