Won Oak Kim, M. This article has been cited by other articles in PMC.
Can we ethically qualify a "right to health care"? This topic page raises some issues to consider when facing these difficult allocation decisions.
What rules guide rationing decisions? Often scarcity can be alleviated by improved efficiency or expanded investment.
Rationing means the distribution of any needed thing or procedure that is in short supply to those who need it in accord with a set of rules that assure fair distribution.
The reasons for shortage can be many. For example, there are many more patients with end stage cardiac disease or liver disease than there are cadaver organs available; expensive equipment may be lacking in a particular region; tertiary care hospital beds may be limited; a particular medication may be extremely costly; few personnel might be trained for a certain technical procedure, insurance coverage is unavailable or of prohibitive cost.
Every physician rations his or her own time available to provide medical services. For the most part, this personal rationing is done by rules of common sense: I will take only as many patients as I can care for competently; I will assure that my attendance is sufficient to guarantee high quality medical care to my patients, etc.
For other kinds of rationing, for instance rationing of ICU beds, these rules of thumb are not enough. More articulate principles are required. In one highly publicized instance of resource allocation, the Seattle Artificial Kidney Center appointed a committee to decide who would receive dialysis treatments, in a rare and expensive resource.
Even so, many more patients required dialysis than there were machines available. The committee turned to "social worth" criteria that is, they tried to weigh the anticipated contributions the patients would make to society were their lives saved.
Many bioethicists argued that a lottery or a "first-come, first-served" criteria would have been more equitable and ethically justifiable. One of the most serious medical shortages, organs for transplantation, has been organized into a national system with criteria that strive for fairness.
The criteria attempt to match available organs with recipients on presumed "objective" grounds, such as tissue type, body size, time on waiting list, seriousness of need. However, even in this system, it is obvious that such a criterion as "serious need" can be used in a manipulative way.
Still, this system is preferable to the subjective use of criteria of social worth and status that would unfairly skew the distribution of organs. Are there ethical criteria for making triage decisions? Again, the common sense rule is to serve persons whose condition requires immediate attention and, if this attention is not given, will progress to a more serious state.
Others, whose condition is not as serious and who are stable, may be deferred. A second sort of triage is indicated in disasters, such as earthquakes, or in military action. The rules of military triage, developed centuries ago, direct the physician to attend first to those who can be quickly and successfully treated in view of a speedy return to the battlefield, or to treat commanders before troops in order to assure leadership.
This sort of disaster triage is applied to civilian disasters by treating persons, such as firefighters or public safety officers, who can quickly return to duty and help others. Disaster triage implies that the most seriously injured may be relegated to the end of the line and left untreated, even at risk of death, if their care would absorb so much time and attention that the work of rescue would be compromised.
This is one of the few places where a "utilitarian rule" governs medicine: This rule is justified only because of the clear necessity of general public welfare in a crisis. Can I make allocation decisions based on judgments about "quality of life"?
Under conditions of scarcity, the question may arise whether a patient's quality of life seems so poor that use of extensive medical intervention appears unwarranted.
When this question is raised, it is important to ask a few questions. First, who is making this quality of life judgment, the care team, the patient, or the patient's family? Several studies have shown that physicians often rate the patient's quality of life much lower than the patient himself does.
If the patient is able to communicate, you should engage her in a discussion about her own assessment of her condition. When considering quality of life, you should also ask: What criteria are being used to make the judgment that the quality of life is unacceptable?
These criteria are often unspoken and can be influenced by bias or prejudice. A dialogue between care givers and the patient can surface some underlying concerns that may be addressed in other ways. For example, residents on a medical floor in an urban public hospital may get discouraged with the return visits of a few chronically ill alcoholic patients and suggest that money is being wasted that could be used for prenatal care or other medically beneficial projects.
While the residents' frustration is understandable, it would be helpful to consider other ways they might interrupt this vicious cycle of repeat admissions.
How could this patient population be supported in ways that might improve health? Quality of life judgments based on prejudices against age, ethnicity, mental status, socioeconomic status, or sexual orientation generally are not relevant to considerations of diagnosis and treatment.
Furthermore, they should not be used, explicitly or implicitly, as the basis for rationing medical services.Table of Contents In addition to adhering to the foregoing ethical standards, a physician shall with any current patient whom the physician has interviewed and/or upon whom a medical or surgical procedure has been performed.
Section Sexual harassment by a physician is considered unethical. Sexual. is driven especially by studies indicating a shockingly widespread incidence of medical errors and a striking lack of consistency in the standard of care patients receive in .
Ethical and legal standards requiring professionals to carefully assess and accurately diagnose clients before commencing any intervention ____________ were developed for a . A selection of medical ethics cases designed to help determine whether medicine is the correct calling for pre-medical students.
Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy's torso. such as people who are immunocompromised like AIDS patients? Is it ethical for. The American Statistical Association’s Ethical Guidelines for Statistical Practice are intended to help statistics practitioners make decisions ethically.
Additionally, the ethical guidelines aim to promote accountability by informing those who rely on statistical analysis of the standards they should expect.
Jan 25, · Studies on human are imperative for medical progress and have expanded our understanding and capability to treat serious diseases and entities. to investigate human radiation experiments and decide upon ethical and scientific standards for evaluating these events.
Physicians commonly conduct clinical .