Keywords: COVID-19, factorial survey, triage, beginning and end-of-life issues, CRONOS-2

Our underlying value orientations shape our views on fundamental aspects of human existence such as birth and death. Values reflect our ideals as a society and our opinions on how medical interventions in boundary situations can be ethically and morally justified. Conflicts over beginning- and end-of-life issues are fundamentally influenced by our value structures and are at the core of political discussions and policies (Walby 2020).
The last Covid-19 pandemic, but also many others before, has shown that when demand for medical treatment outstrips supply, rationing becomes necessary and criteria for rationing need to be put in place, deciding who receives treatment and who does not (May 2008). This prioritization is necessary if there is an imbalance between demand for such treatment and the resources available. The question remains, how to ration scarce resources fairly and efficiently explicitly in a situation of urgency and distress. This paper explores the values and attitudes of lay people in Spain regarding medical triage and its criteria for prioritization of patients suffering in a situation of scarcity of resources.
Applying a factorial survey experimental model, we analyze Spanish citizens´ values and attitudes about fundamental basic ethical principles of distributive justice in medical triage proposed by guidelines developed by national healthcare authorities. We also include other non-medical principles that might be controversial in judging which patient would deserve a scarce resource, in this case, a ventilator. Through the vignette experiment, we test the impact of peoples´ values and principles (utilitarian, egalitarian, libertarian) in boundary situations in which resources are scarce and prioritization is needed.
Moreover, we explore medical triage in copmarative perspective comparatively thorugh the The EVS MORALBOUNDS module in wave 2 of ESS CRONOS-2 panel. It comprises a series of questions concerning moral issues surrounding decisions related to medical triage and other aspects birth and death: Abortion, In-vitro fertilization, Surrogacy, and Euthanasia. For the first time in a cross-national survey, these topics are surveyed together with and can be compared to attitudes regarding how physicians might make triage decisions. The moral attitudes are predicted using the basic human values from the ESS core module, distributive justice beliefs and trust in the health care system, controlling for a set of religious and demographic variables. A comparative descriptive analysis reveals that triage attitudes exhibit minimal cross-national variance across the 12 countries surveyed. In general, individuals tend to accept the prioritisation of younger people and smokers, although acceptance is slightly higher for age-based prioritisation. Public opinion does not express enthusiasm for medical triage, although it does not object to it either. The study's findings indicate that factors shaping attitudes to triage differ from other moral issues surrounding life and birth decisions.