Resource allocation
Who should get the last NICU bed, according to the public?
Open access · cc by · source: Europe PMC
When forced to choose which critically ill newborn gets the only intensive-care bed, ordinary people overwhelmingly chose to save the baby with the better prognosis, except when the difference between babies was tiny.
Study at a glance
- Design
- Cross-sectional — Online survey of lay adults answering repeated hypothetical rationing dilemmas that varied one prognostic factor at a time, plus veil-of-ignorance and lifeboat versions.
- N
- N=109 · Adult Mechanical Turk respondents who completed the questionnaire; the lifeboat item was answered by a subset (88 of 90 chose to save five).
- Population
- Lay members of the public, mostly from the US, recruited online
- Outcome
- Choice between admitting the infant with the better outcome (utilitarian) or tossing a coin (egalitarian) when only one intensive-care bed is available
Structured fields used in claim comparison tables when every cited study has a complete layer.
Key findings
Respondents were strongly utilitarian: in all but one scenario most chose the infant with the better prognosis or cheaper treatment, and utilitarian choices rose as the gap between infants grew. The exception was a one-year difference in life expectancy, where most preferred a coin toss. Answers behind the veil of ignorance did not differ from the ordinary versions, and 98% of those answering the lifeboat case chose to save five rather than toss a coin. Empathy, need for cognition and political views were unrelated to choices, while being a parent or female was linked to some egalitarian answers.
Methodology
Adults recruited online answered 20 hypothetical rationing scenarios in which two newborns differed in chance of survival, severity of future disability, life expectancy or treatment cost. For each they could admit the infant with the better outcome (scored utilitarian), the worse outcome, or toss a coin (scored egalitarian). Two scenarios were repeated behind a 'veil of ignorance' (one of the infants might be their own future child), respondents answered the classic lifeboat case of saving five versus one, and they completed empathy, need-for-cognition and political-conservatism scales.
Limitations
Public intuitions cannot settle what is actually just; the authors say the data feed reflective equilibrium rather than yield normative conclusions. The sample was a small online Mechanical Turk group that may not represent the wider public, and the survey did not ask why people chose as they did, so answers may be quick first reactions sensitive to wording. Scenarios gave both infants equal need, so prioritarian intuitions (favouring the worst off) were not tested, and single-variable comparisons are less realistic than real triage.
How this study connects
Role on claims
Each row is a claim on a concept or method page where this paper supports, challenges, or qualifies the statement. Roles are hand-checked — not a model guess.
In this sample, lay people mostly favoured maximising outcomes, with limits when differences were small.
An online survey of 109 lay adults found strongly utilitarian choices in hypothetical neonatal ICU dilemmas: most chose the infant with better prognosis or cheaper treatment, more so as the gap widened, except for a one-year difference in life expectancy where most preferred a coin toss; veil-of-ignorance versions did not change answers.
Evidence for the claim as stated.
In this sample, lay people mostly favoured maximising outcomes, with limits when differences were small.
An online survey of 109 lay adults found strongly utilitarian choices in hypothetical neonatal ICU dilemmas: most chose the infant with better prognosis or cheaper treatment, more so as the gap widened, except for a one-year difference in life expectancy where most preferred a coin toss; veil-of-ignorance versions did not change answers.
Scope note — Cross-sectional Mechanical Turk sample; the authors say intuitions feed reflective equilibrium rather than settle what is just.
Limits the claim's scope: a different population, assay, or outcome.
Lay respondents in the NICU survey leaned utilitarian, favouring better outcomes and lower costs, while the disability-justice and food-insecurity arguments give priority to the marginalised and worst-off. The survey deliberately gave infants equal need, so it did not test prioritarian intuitions — this is a limit of scope, not a direct refutation.
Evidence for the claim as stated.
Open questions
Tensions this paper is part of
From concept pages' “where studies disagree.” Disagreement means the same question; scope means different assays, populations, or outcomes.
Lay respondents in the NICU survey leaned utilitarian, favouring better outcomes and lower costs, while the disability-justice and food-insecurity arguments give priority to the marginalised and worst-off. The survey deliberately gave infants equal need, so it did not test prioritarian intuitions — this is a limit of scope, not a direct refutation.
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Same topic cluster — not a recommendation engine.