• Utilitarianism - resources should be allocated so as to maximise overall benefit
• Need – prioritising according to urgency and severity of need – however this would not be useful in this case because both patients have the same need and urgency
• Rule of rescue - the duty to save a life in peril where possible – however this would not be useful in this case because both are in need of rescue
• Equity – allocating resources in proportion to need while acknowledging the differing needs of everyone – however this will not be useful in this case because both the patients are equally needy, need the same thing and both needs cannot be met simultaneously
• Proportional equality - equals should be treated equally and unequals unequally in proportion to the morally relevant difference

Other theories, principles and values that might be used to allocate resources, include:

• Allocation according to desert - the most useful or otherwise deserving members of society are prioritised
• Equal shares - giving everyone the same – dividing the resources ‘cake’ into equal parts – but this would not be useful because they cannot effectively share an ITU bed 50/50 or divide it in half
• ‘First come first served’ - people should be treated in order of arrival – but both of the patients arrived at the same time so this will not distinguish between them.
• Random allocation (tossing a coin) -when other things are considered to be equal/there is no decisive factor on which to base a choice, the fairest thing to do is to leave things to chance

QALYs (quality adjusted life years may be used to capture and quantify benefit, overall benefit is then achieved by allocating resources to the intervention that will achieve the most QALYs) should not get a mark unless identified as a way of maximising overall benefit.

Merely stating ‘Justice’ or ‘fairness’ or ‘being fair’ or ‘being just’ are not sufficient for a mark (question states ‘describe’ as opposed to ‘identify’)

Arguments will vary according to the principle, theory or value described but this should be used in the argument (i.e. NOT a different one). 2 marks for producing a strong, sound argument, 1 mark for a weak argument. A sound argument will have premises that are plausibly true, and there will be a clear and logical link between the premises and the conclusion. A weak argument will include premises and a conclusion but the premises may be false/questionable, or the link between premises and conclusion may be unclear. If there are no obvious premises or conclusions, or no attempt to link them together, this does not constitute an argument and no mark should be awarded. For more information on assessing arguments, please see resource on VLE Moodle pages.

Mark only the first argument and not any subsequent points/arguments even if these are better (this is in line with general marking instructions). This first argument mustincorporate the principle, theory or value described  - award zero if not.

Arguments might be based upon:

• Maximising overall benefit – applying normal life-expectancy, we can assume that the female patient has more years left to live and will therefore benefit most from surviving (and her children will also benefit) therefore overall benefit will be maximised if she is prioritised. Quality adjusted life years can be used to make a similar argument – e.g. assuming normal life expectancy and then either assuming a better quality of life for at least some of the years left to live of the younger, non-smoking patient or even assuming both of the patients will an equally good quality of life until they die, the younger patient will be prioritised
• Proportional equality – there are differences between these two patients but the answer will need to explain why these differences are morally relevant as part of the argument (account does not have to be taken of all differences to produce an argument, one would do if it is used effectively – again take the first answer and disregard subsequent efforts UNLESS the answer is discounting differences and giving reasons – which is going above and beyond what is required for 2 marks but should not be penalised).
• Gender only matters insofar as women tend to live longer than men, but the female patient is already younger – so this would enhance the sorts of argument outlined above based on years left to live;
• difference in age –the years each patient has left to live to can be used to create an argument favouring the younger patient or to employ a ‘fair innings’/he’s had his life already type argument to justify not favouring the older patient;
• smoking/non-smoking - it might be argued that the smoking patient has contributed to their ill-health by their choices and therefore the two patients are unequally deserving because, on the facts presented, one may bear some responsibility for the severity of his illness; or it may be argued that his choices suggest that he values his health less than those who have looked after their health