Tossing a Coin: Preferences for Rank-Ordering in Triage Decisions

Abstract The discussion about the fair allocation of scarce medical resources through triage decisions gained momentum during the COVID-19 pandemic. Ethical experts proposed to maximize the overall treatment benefits by prioritizing patients with the highest estimated post-treatment length of life, and apply a random lottery if the estimated post-treatment length of life for two patients is equal. However, implementing expert ethics requires the procedures to at least coincide with the preferences of the general public to ensure trust in institutions and social cohesion. Although there is a growing body of research on preferences of the public in triage decisions, evidence for preferences in accordance with this rank-ordering approach is lacking. To address this research gap, 1,998 English-speaking adults from North America and Europe completed an online conjoint experiment. We find a close match between the rank-ordering approach and participants’ preferences. We discuss implications and provide guidance for future research.