Rationing Healthcare

1
Rationing Healthcare

• Imagine that you are a doctor running an
  Intensive Care Unit (ICU). You have three
• available beds, and five critically ill patients
  waiting to be admitted. Do you
• a) Prioritize the sickest patients, who most
  urgently need treatment,
• b) Prioritize the healthiest patients, who are
  most likely to recover, or
• c) Admit patients on a first-come, first-serve
  basis?

2
Rationing Healthcare

• Respect for Persons dictates that individuals
  should be treated as autonomous agents, and that
  persons with diminished autonomy should be
  protected from harm
• Beneficence describes the obligation for medical
  providers to make efforts to secure the
  well-being of others, including both the negative
  injunction to do no harm, and the positive
  requirement to maximize benefits and minimize
  risks
• Justice mandates that social risks and benefits
  must be fairly distributed.

3
Rationing Healthcare

• Good decision-making about life-sustaining
  treatments depends upon the same process of
  shared decision-making that should be part of
  health care in general.
• The hallmark of an ethically sound process is
  always that it enables competent and informed
  patients to reach voluntary decisions about care.

4
Rationing Healthcare

• Utilitarianism Emphasizes the greatest good for
  the greatest number and seems compatible with
  resource allocation concerns however, debate
  inevitably emerges around differing definitions
  of the greatest good.
• Egalitarianism Focuses on doing the most good
  for the individual based on equity as equal
  health (as advocated by Rawls). Egalitarianism
  also often runs into the definition conundrum,
  i.e., what is equality and how can equality be
  reality given that equal access to services is
  not always guaranteed, particularly in rural and
  underserved areas of the country.

5
Rationing Healthcare

• To ration is to distribute equitably.
• Rationing occurs only when someone willing and
  able to pay money for a service is somehow denied
  access to it.
• Rationing is any allocation of a scarce supply of
  a good or service to users who would otherwise
  want more of it, including charging a money price
  sufficient to limit demand to the available
  supply.

6
Arguments FOR Euthanasia

• Principle of Self-Determination
• Utilitarian view Action is morally right if it
  decreases misery.
• Mercy

7
Arguments AGAINST Euthanasia

• Slippery slope?
• Life has priority
• Makes all other choices impossible.
• Arbitrary
• Old people often coerced into feeling theyre a
  burden
• Crisis in health care costs
• Legal doctrines on substituted judgment
  mentally incompetent, exercised by others who
  interpret patients wishes.
• Expanded definitions of terminal illness.
• Prejudice against citizens with disabilities
• Character of the medical profession