Biomedical Ethics: Assignment Week 5
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Chapter 19
Is Rationing of Health Care Ethically Defensible?
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Background Information
• Health care spending is a major concern in many industrialized nations.
• The post-PPACA future promises even greater issues concerning the funding of health care and the demand for services.
• Health care spending poses serious problems both economically and ethically.
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Background Information
• A serious debate revolves around the issue of rationing of health care.
• Some maintaining it should never be done. • Some say denying services If beneficial and
desires. • Others say we are already rationing health
care.
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Definition of Rationing
• In the strictest sense, we are not rationing health care.
• The basic definition is to provide equal portions of a scarce good to all.
• Rationing is a way of distributing resources outside of the market system.
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Definition of Rationing
• In the United States, we have not decided whether health care is a commodity or social good.
• Some authors seem to equate rationing with cost-benefit analysis.
• However, the definition for rationing is not cost benefit analysis.
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Definition of Rationing
• Rationing has also been defined as • Distribution of scarce goods, • Prioritization of services, and • Allocation of financial resources. • Rationing is also concerned with limiting
spending by limiting consumption.
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Limiting Access
• If accesses is limited, there needs to be a way to define who has access and who does not.
• One way to do this is by chance. • Another way is to determine criteria for
decision-making.
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What is a Practical Definition?
• Rationing of health care refers to: • Policies and procedures that result in
individuals being denied services that would be of significant medical benefit to them.
• Rationing occurs for reasons other than absolute scarcity or inability to pay.
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Rationing and Ethics
• Health care must compete with other social goods for scarce resources.
• How can a society make an ethics- based decision about where resources should be placed?
• Certain conditions must be met before decisions can be made.
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Rationing and Ethics
• Conditions for consideration include: • Policies and procedures for limiting access to
treatment are applied equitably to all. • Self-imposed limits created through
democratic processes.
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Rationing and Ethics
• Conditions for consideration include: • There are other equally important needs
competing for scarce resources. • There are no alternative ways to produce
equivalent savings. • Savings from denied services will benefit other
patients or be invested in equally important social needs.
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What About the Real World?
• Assessment of spending on social goods should be made using concrete terms.
• Deployment of resources may be inefficient and should be improved.
• Decisions should be made about what happens to any savings that occurs from rationing.
• Equitable application of rationing policies may not be possible.
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Who Makes Rationing Decisions?
• Inclusive and open procedures are considered to be best.
• Some believe that inclusiveness could lead to tragic choices.
• Kantian principles always be considered in making these decisions.
• Democratic principles should be employed even if their role is not clear.
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In Summary…
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- Slide Number 1
- Chapter 19
- Slide Number 3
- Background Information
- Background Information
- Definition of Rationing
- Definition of Rationing
- Definition of Rationing
- Limiting Access
- What is a Practical Definition?
- Rationing and Ethics
- Rationing and Ethics
- Rationing and Ethics
- What About the Real World?
- Who Makes Rationing Decisions?
- In Summary…