Fair allocation concerns both the reason for choosing and the procedure used. A consistent rule may still reproduce disadvantage if its inputs reflect unequal access to earlier care. An ethical discussion should separate clinical estimates, which need evidence, from judgments about whose needs count, which require public justification.
Consider a fictional clinic deciding between two applicants with similar expected benefit but very different travel barriers. A formally equal appointment process might still be harder for one to use. Fairness can therefore require attention to notices, transport, language, and appeal, as well as the final ranking. This is a discussion of allocation principles: applying them in actual care requires clinical evidence, appropriate expertise, and the responsibilities of the institution involved.