Table 3 Substantive and procedural values in published ethical frameworks and guiding principles for critical care triage during a pandemic (n = 30)

Distributive justice or fairness

Fairness in how resources are allocated across members of a group.

8 (26.7)

Farrell (2020) [81]; Han (2020) [35]; Leclerc (2020) [42]; Seethala and Keller (2020) [82]; Rhodes (2020) [83]; Steinberg (2020) [84]; Vergano (2020) [53]; Vincent and Creteur (2020) [50]

Duty to plan

Planning for the management of ethical issues that may arise.

2 (6.7)

Han (2020) [35]; Committee (2020) [47]

Duty to provide care

“Palliative care protocol (when patient does not qualify for critical care allocation).”; “The concept of triage by a senior clinician(s) without direct clinical obligation and a support system to implement and manage the triage process.”

13 (43.3)

Christian (2010) [85]; Christian (2014) [11]; Cinti (2009) [86]; Daugherty Biddison (2014) [87, 88]; Devereaux (2008) [89]; Eastman (2010) [90]; Einav (2014) [91]; Han (2020) [35]; Herrerros (2020); Lin and Anderson-Shaw (2009) [23]; Powell (2008) [24]; Rubinson (2005) [92]; Silva (2012) [93]

Equality

“Triage decisions will not be based on race, ethnicity, gender, disability, insurance status, immigration status, social class, or other non-clinical factors.”

4 (13.3)

Marckmann (2020) [46]; Montgomery (2020) [52]; Rhodes (2020) [83]; Steinberg (2020) [84]

Equity

“Triage decisions during the epidemic should apply to all patients who may require intensive care, not just COVID-19 patients.”

17 (56.7)

Cheung (2017) [94, 95]; Christian (2010) [85]; Christian (2014) [11]; Cinti (2009) [86]; Devereaux (2008) [89]; Dries (2014) [96]; Daugherty Biddison (2014) [87, 88]; Eastman (2010) [90]; Emanuel [10]; Herrerros (2020); Leclerc (2020) [42]; Powel (2008) [24]; Tillyard (2010) [97]; Silva (2012) [93]; Real de Asua (2020) [32]; Rhodes (2020) [83]; Steinberg (2020) [84]

Reciprocity

Resources allocated based on societal contributions (e.g., caregivers, healthcare providers - feelings of reciprocity).

5 (16.7)

Daugherty Biddison (2014) [87, 88]; Daugherty Biddison (2018) [98]; Eastman (2010) [90]; Emanuel [10]; Silva (2012) [93]

Stewardship

“Triage decisions regarding the provision of critical care should be guided by the principle of seeking to help the greatest number of people survive the crisis.”

20 (66.7)

Cheung (2017) [94, 95]; Christian (2010) [85]; Christian (2014) [11]; Cinti (2009) [86]; Daugherty Biddison (2014) [87, 88]; Daugherty Biddison (2014) [87, 88]; Daugherty Biddison (2018) [98]; Eastman (2010) [90]; Emanual (2020); Han (2020) [35]; Janig (2020) [30]; Marckmann (2020) [46]; Powell (2008) [24]; Rubinson (2005) [92]; Silva (2012) [93]; Steinberg (2020) [84]; Tabery and Mackett (2008) [99]; Real de Asua (2020) [32]; Rhodes (2020) [83]; Tillyard (2010) [97]

Trust

“Review of triage decisions (daily retrospective review).”

10 (33.3)

Christian (2014) [11]; Chung (2017); Cinti (2009) [86]; Daugherty Biddison (2014) [87, 88]; Daugherty Biddison (2018) [98]; Lin and Anderson-Shaw (2009) [23]; Powell (2008) [24]; Rubinson (2005) [92]; Silva (2012) [93]; Tabery and Mackett (2008) [99]

Reasonable

Critical care resources be allocated based on specific triage criteria, irrespective of whether the need for resources is related to the current disaster/pandemic or an unrelated critical illness or injury.

12 (40)

Cheung (2017) [94, 95]; Christian (2010) [85]; Christian (2014) [11]; Daugherty Biddison (2014) [87, 88]; Devereaux [89]; Dries (2014) [96]; Eastman (2010) [90]; Einav (2014) [91]; Lin and Anderson-Shaw (2009) [23]; Powell (2008) [24]; Rubinson (2005) [92]; Silva (2012) [93]

Open and transparent

“The criteria for triage should be transparent, public, and as shared as possible. The triage process is the responsibility of the entire society.”

14 (46.7)

Cheung (2017) [94, 95]; Christian (2010) [85]; Christian (2014) [11]; Daugherty Biddison (2014) [87, 88]; Daugherty Biddison (2018) [98]; Han (2020) [35]; Lin and Anderson-Shaw (2009) [23]; Marckmann (2020) [46]; Real de Asua (2020) [32]; Rubinson (2005) [92]; Silva (2012) [93]; Seethala and Keller (2020) [82]; Steinberg (2020) [84]; Valiani (2020) [29]

Inclusive

“Hospitals should establish procedure in advance of a crisis. These protocols should be developed regionally and with input from stakeholders (including the public).”

7 (23.3)

Cheung (2017) [94, 95]; Christian (2010) [85]; Christian (2014) [11]; Daugherty Biddison (2014) [87, 88]; Daugherty Biddison (2018) [98]; Rubinson (2005) [92]; Silva (2012) [93]

Responsive

“Prioritization guidelines should differ by intervention and should respond to changing scientific evidence.”

4 (13.3)

Devereaux (2008) [89]; Emmanuael (2020); Real de Asua (2020) [32]; Valuani (2020)

Accountable

“Triage Review Board-to oversee switch from traditional ethics of individual autonomy to an ethics of public health.”

5 (16.7)

Christian (2014) [11]; Lin and Anderson-Shaw (2009) [23]; Seethala and Keller (2020) [82]; Tabery and Mackett (2008) [99]; Valiani (2020) [29]