The issue is especially relevant as the first round of Pfizer’s COVID-19 vaccine is distributed this week. Bioethicists already have expressed concerns that doses of the vaccine will be siphoned to the well-to-do and the well-connected — and away from the frontline medical workers and nursing home residents who are supposed to receive the initial vaccinations.

Some medical institutions have put in place procedures to ensure that medications in short supply are distributed fairly. The New York University School of Medicine and Janssen Pharmaceuticals, for example, created a Compassionate Use Advisory Committee to review requests for experimental drugs.

But Leonard Fleck, acting director of the Center for Ethics and Humanities in the Life Sciences at Michigan State University, says it largely falls on doctors and nurses to object if they think a patient is receiving special treatment because of wealth or status. That’s a difficult stand to take if it’s a hospital executive, a big donor or a crony of the president who’s pushing for VIP care. “It’s where moral courage comes in,” Fleck says.