Biomedical Ethics: Assignment Week 5

Chapter 19

Is Rationing of Health Care Ethically Defensible?


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.


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



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.


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.


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.


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



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.


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.


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.


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.


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.


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.


In Summary…


  • 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…