This paper tests the factorial structure of a questionnaire comprising seven health care rationing criteria (waiting time, ‘rule of rescue’, parenthood of minors, health maximization, youngest first, positive and negative version of social merit) and explores the adherence to them of 254 Portuguese health care professionals, when considered individually and when confronted with two-in-two combinations. Data were collected through a self-administered questionnaire where respondents faced hypothetical rationing dilemmas comprising one rationing criterion and dichotomous options pairs with two rationing criteria. Confirmatory factor analysis and multinomial logistic regressions were used to validate the structure of the questionnaire and the data. The findings suggest that: (i) the hepta-factorial structure of the questionnaire presented a good fit of the data; and (ii) support for rationing criterion depends on whether they are individually considered or confronted in dichotomous options pairs. When only one criterion distinguishes the patients, healthcare professionals support six criteria (by descending order): waiting time, rule of rescue, health maximization, penalization of patients’ risky behaviors, youngest first and being parent of a young child. When two criteria were confronted, immediate threat of life/health and large expected benefits were the most preferred. Conversely, the positive version of social merit was an unappreciated rationing criterion.

In a disaster, physicians are forced to make challenging and heartbreaking ethical decisions under conditions of physical and emotional exhaustion. Evidence shows that the conditions of stress that mark disasters can undermine the process of ethical decision-making. This results in biased allocation of scarce resources, fewer utilitarian and altruistic decisions, and a wider variation in decisions. Stress also predisposes clinicians to decision strategy errors, such as premature closure, that lead to poor outcomes. The very ability to make sound and ethical decisions is thus a scarce resource. Ethical frameworks underpinning disaster protocols enumerate many physician obligations, but seldom articulate the risk posed by having decisions made ad hoc by decision-makers who are compromised by the stress of the concurrent crisis. We propose, therefore, that a “duty of mind”—the obligation to make critical decisions under the clearest possible state of thought—be added to ethical frameworks for disaster response. Adding the duty of mind to the pillars on which planning is based would force attention to a moral imperative to include decision support tools in disaster planning. By moving the consideration of possible choices to a moment when time and consultation facilitate clear and considered thought, the duty of mind is upheld. (Disaster Med Public Health Preparedness. 2018;12:657–662)

We describe an evaluation model to guide public coverage of new predictive genetic tests in Ontario, Canada. The model confronts common “gray zones” in evaluation and coverage policy for challenging new technologies. Analysis addresses three domains of the evaluation picture. The first specifies evaluative criteria (purpose, effectiveness, additional effects, unit cost, demand, cost-effectiveness). The second induces or deduces acceptable cutoffs for each criterion. The third domain addresses the need to make decisions under uncertainty and to respond to “gray” evaluations with conditional-coverage decisions. The evaluation criteria should be applied within sound decision-making processes.