Resource-Allocation Based on Survivability Biomarkers Legality

Introduction

Resource allocation based on survivability biomarkers refers to using biological indicators—such as laboratory results, genetic markers, organ-function measures, or validated prognostic scores—to help decide who receives scarce medical resources. These resources may include intensive-care beds, ventilators, transplant organs, or expensive life-saving therapies.

The legal and ethical difficulty is that a biomarker may estimate a patient’s likelihood of benefiting from treatment, but it cannot establish the value of a person’s life. A lawful allocation system must therefore use clinically relevant evidence while protecting equality, dignity, privacy, and fair access. Biomarker-based prioritisation is not automatically unlawful; its legality depends on the marker’s validity, the decision it informs, and safeguards against discrimination or arbitrary exclusion.

Legal Framework

In India, there is no standalone statute specifically authorising allocation of scarce treatment solely through “survivability biomarkers.” The legality must be assessed under constitutional guarantees, medical standards, applicable health laws, and the rules governing the resource in question.

Article 14 prohibits arbitrary state action and requires rational, non-discriminatory criteria. Article 21 protects life, dignity, and personal liberty. A biomarker-based system must therefore demonstrate a legitimate medical purpose, reliable evidence, and a fair decision-making process. Biomarker results may inform clinical prognosis, but should not operate as an unquestionable or automatic exclusion rule.

The World Health Organization states that resource allocation should be based on ethically relevant criteria and should not arbitrarily discriminate on grounds such as disability, gender, race, or other irrelevant characteristics. It also recognises that where patients have similar expected benefit, a fair random selection process may be appropriate.

World Health Organization

Case Laws

1. Paschim Banga Khet Mazdoor Samity v. State of West Bengal (1996) 4 SCC 37

The Supreme Court held that failure of government hospitals to provide timely medical treatment can violate Article 21. The State has a constitutional obligation to safeguard life.

Relevance: A hospital cannot use a biomarker score as a convenient reason to deny care without a medically defensible assessment and a fair allocation policy. The case does not directly concern biomarkers; it supplies the broader Article 21 principle.

2. Common Cause v. Union of India (2018) 5 SCC 1

The Court recognised dignity and autonomy in end-of-life decisions and established safeguards for advance directives and withdrawal of life-sustaining treatment.

Relevance: Prognostic evidence can inform clinical decisions, but it must be considered alongside patient autonomy, dignity, and appropriate safeguards. This judgment is relevant by analogy; it does not prescribe biomarker-based triage.

3. In Re: Distribution of Essential Supplies and Services During Pandemic, Suo Motu W.P. (C) No. 3 of 2021, order dated 30 April 2021

The Supreme Court examined allocation and distribution of essential medical supplies during the COVID-19 crisis, including oxygen, medicines, and vaccines. It addressed the need for coordinated and reasoned allocation during scarcity.

Indian Kanoon

Relevance: Public allocation policies must be reasoned and responsive to medical need. The order does not specifically approve survivability biomarkers, but supports transparent, accountable resource-allocation systems.

4. Vidya Ramesh Chand Shah v. State of Gujarat (Gujarat High Court, 21 November 2022)

The Court considered organ-transplant recipient registration and allocation rules. It held that state guidelines imposing domicile requirements lacked a proper legal basis and reasonable nexus to the objective, violating Article 14.

Indian Kanoon

Relevance: Allocation criteria for scarce organs must have lawful authority and a rational connection to their purpose. A biomarker criterion should similarly be validated, relevant, and not merely an arbitrary barrier.

Conditions for Lawful Biomarker-Based Allocation

A defensible system should:

Use clinically validated biomarkers relevant to the specific treatment and patient population.

Consider biomarkers as one part of an individual clinical assessment—not as a substitute for medical judgment.

Avoid criteria that indirectly discriminate against persons with disabilities, older people, or groups underrepresented in biomarker research.

Provide transparent criteria, documented reasons, periodic reassessment, and a practicable review or appeal process.

Protect biological and genetic data through appropriate privacy and confidentiality safeguards.

Use an impartial tie-breaker, such as a lottery, when patients have materially similar prognoses.

Conclusion

Resource allocation based on survivability biomarkers may be lawful when it is evidence-based, medically relevant, non-arbitrary, and subject to meaningful safeguards. It becomes legally vulnerable when a biomarker is treated as an infallible predictor, when the system unfairly excludes protected or disadvantaged groups, or when decisions lack transparency and review. The central legal principle is that biomarkers may help estimate treatment benefit; they must not be used to measure a person’s worth.