Identifying ethical values for guiding triage decisions during the COVID-19 pandemic: An Italian ethical committee perspective using Delphi methodology

Anita Zeneli, Giovanni Brandi, Giuseppe Di Pasquale, Danilo Orlandini, Piero De Carolis, Francesca Bravi, Francesco Pugliese, Elisabetta Poluzzi, Fausto Catena, Filippo Giovanardi, Giorgia Valpiani, Renato Mantovani, Eugenia Magnanimi, Primiano Iannone

Research output: Contribution to journalReview articlepeer-review


Objectives This study aimed to identify the guiding ethical principles that should be considered for critical resource allocation during pandemic emergency situations, and especially for the COVID-19 outbreak. The secondary objective was to define the priority to be assigned to each principle. Setting The study was conducted from March to June 2020 within the context of an ethical committee (EC) in Northern Italy. Participants Eleven EC members and five additional external healthcare and bioethical professionals, forming a multidisciplinary panel, took part in the study. Primary and secondary outcome measures The compilation of a list of ethical principles (maximum of 10 items) and their priority ranking and application within an emergency pandemic context was established as the expected outcome of this work. Results A consensus on 10 guiding ethical principles was reached by the multidisciplinary panel. Transparency ranked first on the priority list as the most frequently voted principle, followed by the number of lives saved, life-years saved, respect for individuals' autonomy and equity. Other principles including life cycle, € sickest first', reciprocity, instrumental value and lottery were also considered appropriate as potential tiebreakers. These principles were discussed and made consistent with the current Italian pandemic context by producing an explanatory document. Conclusions The identified principles could be used in preparedness plans to guide resource allocation during pandemic events. By combining their rank and relevance in relation to disease, health system organisations, social and economic settings, and critical resources at risk of scarcity, these principles could help to maximise the benefit of resource use for the community, thus reducing inequalities for individuals.

Original languageEnglish
Article numbere043239
JournalBMJ Open
Issue number5
Publication statusPublished - May 18 2021


  • COVID-19
  • ethics (see medical ethics)
  • intensive & critical care
  • medical ethics

ASJC Scopus subject areas

  • Medicine(all)


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