Public attitudes toward pandemic triage: Evidence from conjoint survey experiments in Switzerland

Abstract

The question of how to implement medical triages has become highly salient during the COVID-19 pandemic and continues to be actively discussed. It is important to know how members of the general public think about this issue. For one, knowledge about the public's standpoint can help resolve important questions where ethical considerations are by themselves not sufficient, for instance whether the patient's age should matter. It can also help identify if more communication with the public about medical ethics is needed. We study how members of the Swiss public would allocate intensive medical care among COVID-19 patients using data from two original conjoint survey experiments conducted in Switzerland in the context of the first and second pandemic waves in 2020 ( N = 1457 & N = 1450). We find that our participants would not base triage decisions on the patient's age. However, they do give much importance to the patient's behavior prior and during illness, discriminate against non-nationals, and assign only a relatively small and inconsistent role to medical considerations. Our findings suggest that there is a need for more communication with the public about the ethics of medical triage.

The citizen preferences–positive externality trade-off: A survey study of COVID-19 vaccine deployment in Japan

“…Our results show that the Japanese prioritize Japanese candidates for vaccine receipt over foreign candidate recipients. The finding that fellow citizens are prioritized in the allocation of scarce resources is consistent with the findings of previous works such as Reeskens et al (2021) , Vinay et al (2021) , Knotz et al (2021b) , and Larsen and Schaeffer (2021) . Additionally, our results indicate that geopolitical concerns impose a penalty on foreigners.…”

“…On average, respondents prioritized Japanese citizens over foreigners to a substantial degree across visa types, citizenship status, occupation, demographics, and family risk characteristics, such as living with an elderly individual or a child. The prioritization of fellow citizens is deeply rooted, which is consistent with the results of Knotz et al (2021b) . Since we set up scenarios in which there was a shortage of vaccines, we interpret this citizenship prioritization result as due to concerns about the allocation of scarce resources, as in the ICU triage case discussed in Knotz et al (2021b) .…”

“…The prioritization of fellow citizens is deeply rooted, which is consistent with the results of Knotz et al (2021b) . Since we set up scenarios in which there was a shortage of vaccines, we interpret this citizenship prioritization result as due to concerns about the allocation of scarce resources, as in the ICU triage case discussed in Knotz et al (2021b) .

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“…A shared concern in the work on vaccine hesitancy is that such reluctance might mitigate the positive externality associated with vaccination. In addition, the equitable allocation of scarce resources as related to vaccine distribution and ICU triage practices that considered age, occupation, ethnicity, and citizenship was an issue ( Knotz et al, 2021b ; Larsen & Schaeffer, 2021 ; Reeskens et al, 2021 ; Vinay et al, 2021 ).…”

“…When welfare is considered to be a type of redistribution of scarce resources, citizens’ perceptions of deservingness tend to be distorted toward people similar to themselves ( Knotz et al, 2021a ). If ICU beds are considered a scarce resource, it is not surprising that competition for ICU beds leads to attitudes of exclusion toward foreigners ( Knotz et al, 2021b ). However, as rational creatures, we should also be able to understand the positive externalities of medicine, and this understanding should lead us toward an attitude of inclusion that benefits both guests and citizens, which makes our nation safer.…”