Equity in the ICU: an exploratory qualitative study of the ethical acceptability of a reserve system for allocating limited ICU resources

Dominant models of prioritising resources in intensive care unit (ICU) settings under conditions of severe resource scarcity, such as a pandemic, are likely to replicate and potentially exacerbate existing health inequities. One proposal is to advance equity by reserving a proportion of ICU resources, such as beds, for members of specific groups. This qualitative study explored the ethical acceptability of a reserve bed system (RBS) for healthcare workers and for indigenous Māori in the Aotearoa New Zealand context. Participants included Māori and non-Māori clinicians working in ICU settings, and non-clinical staff with expertise in ICU management and policy. Although there was a consensus on the urgency of addressing health inequities in New Zealand, especially for indigenous Māori, participants identified critical ethical challenges in implementing an RBS in the ICU setting. These findings contribute to the broader literature on the ethics of reserve systems for priority-setting.