 Many cases of absolute scarcity lie at the intersection of public health and clinical ethics and, depending on the national health system, maybe more or less under public health authorities to resolve. These include the deployment of antivirals and ICU beds during an influenza pandemic but also the allocation of solid organs or of cancer drugs that are in short supply because of production challenges (Unguru et al. 2014). Consider the case of solid organs. Simple notions of fairness might suggest that scarce life-saving organs be distributed randomly among a pool of those in need or on a first-come, first-served basis (Arras 2005; Broome 1984; Silverman and Chalmers 2001). However, if, for example, either of these principles resulted in an 85-year-old being selected over a ten-year-old, objections could be mounted from a utilitarian, QALY or DALY perspective. Objections could also be mounted from what is sometimes called the “fair innings” perspective in which a priority is placed on ensuring that people survive to experience the later stages of life before anyone who has already experienced those stages is assisted. Competing concepts of fair chances and just outcomes have dominated this literature, and complex national systems have developed to allocate solid organs that generally rely on a mix of distributive principles. The Complete Lives System is one attempt to integrate several principles in one general strategy for allocating scarce resources (Persad, Wertheimer, and Emanuel 2009), while other integrated, multi-principle strategies have been proposed for the allocation of particular kinds of scarce resources like ventilators in the context of pandemic influenza (Daugherty Biddison et al. 2018).