Which of the following is NOT typically a guiding ethical principle in resource allocation during mass casualty events?

• A. Maximizing benefits
• B. Fairness without bias
• C. Prioritizing the worst-off
• D. Random chance selection without criteria

Answer: (D)

In mass casualty situations, the aim is to allocate scarce resources in a way that saves the most lives while treating people fairly. The guiding principles typically emphasized are: maximizing benefits (prioritizing actions that save the most lives or life-years), fairness without bias (ensuring equal consideration regardless of personal characteristics), and prioritizing the worst-off (giving some priority to those with the greatest need or highest risk of deterioration if that improves outcomes). Random chance selection without criteria does not fit as a guiding principle because it introduces arbitrariness and undermines both efficiency and equity. It might only be considered as a last-resort tiebreaker when clinical criteria cannot distinguish between patients, but it is not a primary principle guiding how to allocate resources.