As a consequence of several changes in the world, health care systems are put under considerable strain. The ongoing pandemic is one example. The strained situation calls for several immediate actions. However, and perhaps more importantly, it raises questions about how to strengthen the robustness of health care systems to withstand future challenges. This talk focuses on the ethical dimensions of working with the resilience of a health care system, more specifically, the technical infrastructure of a hospital.

The concept of resilience is a graded, rather than binary, concept. A health care system can be resilient to a certain degree at a certain time against a specific set of disruptions. To strengthen the robustness of a hospital’s technical infrastructure, may involve large investments, such as building back-up systems for electricity or water supply. This means that decisions about resource allocation must be taken when increased resilience is weighed against, for example, providing treatment for patients that are in current need of health care. Accordingly, the ethical question at stake when building resilience is what level of robustness that should be chosen.

The challenge for contemporary priority setting ethics when applied to building resilience arises from approaching priority setting as the ranking of different health conditions and their treatments (condition-treatment pairs). Contemporary principles for priority setting lack implications for several priority objects relevant for resilience that cannot be translated into condition-treatment pairs, for example, electricity and water supply. Much of the contemporary discussion in priority setting ethics have been presupposing that a certain technical infrastructure is already in place. However, these principles cannot be action guiding with regard to striking the right balance in the hospital’s robustness. We argue that this challenge can be handled by introducing a dimension of precaution in priority setting ethics.