Health care resources are finite and often scarce. This forces either explicit or implicit resource allocation – or rationing – decisions. When explicit rationing is not clearly defined and health care professionals face scarcity of resources, they must perform bedside rationing. The practice of rationing, including bedside rationing, raises ethical questions of justice as well as cost versus utility. While several approaches have been developed to address these ethical questions, none have achieved consensus on either ethical validity or prioritization. Moreover, the ethical problems of both explicit and implicit rationing have further implications when questions of bias are introduced. Since unaddressed bias can lead to unjust disparities in health outcomes, there is an ethical imperative to reduce or eliminate bias in health care decision-making. This is supported by a respect for human vulnerability, both in the general sense and in terms of special vulnerability. Many factors could affect bias in health care decision-making, but bias related to adult age may have a special importance for the debate on rationing. Age is often included as an explicit justification for health care rationing, although consensus on the ethical grounding of this argument has not been established. This study employs a systematic literature reviews to clarify key questions related to bias in bedside decision-making due to patient age. These questions include clarification on concepts related to bedside rationing, age and decision-making bias, and bias related to bedside decision-making.