Four Principles of Medical Ethincs
Beneficnec
Nonmaleficence
Autonomy (of the patient)
Justice
Distributive Justice
Equal access for all, or income dependent access
Ethical Dilemmas Old & New
Financial interests of the physician are not ethical dilemmas
Late 20c. societal issues began to come into play--taking people off respirators
New fiscal realities: conflict wetween beneficence and nonomaleficence and issues of distributive justice; and individual right ot autonomy and society’s claim to distributive justice.
What is Rationing?
"The limitation of resources, including money, oging to medical cares such that not all care expected to be beneficial is provided to all patietnsl and the distribution of theses limined resources in a fair maner."
Commodity Scarcity: The Case of Organ Transplants
Evaluate people based on medical conditions and time on the waiting list. Material scarcity.
Fiscal Scarticy & Resouce Allocation
No national structure within which to effect a trade off between savings and benefits
The Relationship of Rationing to Cost Control
There is plenty of fat in the system today--no need for rationing yet, however if things continue to advance we will need it at some point
Care Provided to Profoundly Ill People
28% of Medicare was spent on the last year of life
There is no way to take this money and distribute it more equally than it is now
Methods for reducing interventions for profoundly and terminally ill patients: restrict the user of CPR in certian explicit cases; clearly define at what mental state they are not worth keeping alive
Rationing by Medical Effectiveness
Medical effectiveness and cost--how many patient years per dollar?
Rationing for Society as a Whole
Best for the patient is not always what is best for the society, but the two are linked (patient and society) so they can not be viewd as seperate entities
Rationing Within One Health Program: The Oregon Plan
rationing to bring 100,000 more people under care
not rationed in other states
huge inefficiencies in the state system were not illiminated first
Rationing Within One Institution: Intensive Care
A Basic Level of Gauranteed Medical Benefits
What should the basic level be?
The Ethics of Health Care Financing
Insurers have to experience rate to keep competetive--not compatible with distributive justice
what about the patients eating/smoking/drinking habits?
Who Allocates Health Care Resources?
physicians vs. insurers