Abstract
All approaches to healthcare rationing are underpinned by core ethical principles. These principles are implicit to certain worldviews – a collection of values that inform the way in which we view and act in the world around us. As a result, the principles used to make ethical arguments, frame research, and write policy for health rationing ultimately reflect the values and the worldviews of those at the decision-making table. Often without realising, the ethical principles and frameworks used to ration health resources privilege a Pākehā or Western worldview. These principles consequently deprioritise the values of those who are not represented in the decision making process, and contribute to worsening health inequities. The COVID-19 pandemic has highlighted the potential for rationing guidelines to have the same effect on Māori health if Aotearoa’s ICU capacity became scarce and needed to be rationed. In order to ensure Māori have equitable access to ICU resources during periods of absolute scarcity, a rationing approach adopted in Aotearoa needs to be able to commit meaningfully to equity and uphold the Crown’s constitutional obligations under te Tiriti o Waitangi. It is this consideration of equity, anti-racism and justice that reflects the need for a way of healthcare rationing that upholds and centres the worldviews of Māori. The primary aim of this thesis is to inform debate around how a Reserve Bed System could be a solution to providing equitable, fair, and life-saving ICU services to Māori that do not worsen inequities or break Crown obligations under Te Tiriti o Waitangi.