Abstract
Questions of resource allocation can pose practical and ethical dilemmas for clinicians. In the Aristotelian conception of distributive justice, the unequal allocation of a scarce resource may be justified by morally relevant factors such as need or likelihood of benefit. Even using these criteria, it can be difficult to reconcile completing claims to determine which patients should be given priority. To what extent the physician's fiduciary duty toward a patient should supersede the interests of other patients and society as a whole is also a matter of controversy. Although the courts have been reluctant to become involved in allocation decisions in health care, they expect physicians to show allegiance to their patients regardless of budgetary concerns. The allocation of resources on the basis of clinically irrelevant factors such as religion or sexual orientation is prohibited. Clear, fair and publicly acceptable institutional and professional policies can help to ensure that resource allocation decisions are transparent and defensible.
Full Text
The Full Text of this article is available as a PDF (143.9 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Daniels N. Four unsolved rationing problems. A challenge. Hastings Cent Rep. 1994 Jul-Aug;24(4):27–29. [PubMed] [Google Scholar]
- Hadorn D. C. Setting health care priorities in Oregon. Cost-effectiveness meets the rule of rescue. JAMA. 1991 May 1;265(17):2218–2225. [PubMed] [Google Scholar]
- Hauptman P. J., O'Connor K. J. Procurement and allocation of solid organs for transplantation. N Engl J Med. 1997 Feb 6;336(6):422–431. doi: 10.1056/NEJM199702063360607. [DOI] [PubMed] [Google Scholar]
- Jecker N. S., Berg A. O. Allocating medical resources in rural America: alternative perceptions of justice. Soc Sci Med. 1992 Mar;34(5):467–474. doi: 10.1016/0277-9536(92)90201-z. [DOI] [PubMed] [Google Scholar]
- Kitzhaber J., Kemmy A. M. On the Oregon trail. Br Med Bull. 1995 Oct;51(4):808–818. doi: 10.1093/oxfordjournals.bmb.a072996. [DOI] [PubMed] [Google Scholar]
- Levenson J. L., Olbrisch M. E. Psychosocial evaluation of organ transplant candidates. A comparative survey of process, criteria, and outcomes in heart, liver, and kidney transplantation. Psychosomatics. 1993 Jul-Aug;34(4):314–323. doi: 10.1016/S0033-3182(93)71865-4. [DOI] [PubMed] [Google Scholar]
- Levinsky N. G. The doctor's master. N Engl J Med. 1984 Dec 13;311(24):1573–1575. doi: 10.1056/NEJM198412133112412. [DOI] [PubMed] [Google Scholar]
- Mendelssohn D. C., Kua B. T., Singer P. A. Referral for dialysis in Ontario. Arch Intern Med. 1995 Dec 11;155(22):2473–2478. [PubMed] [Google Scholar]
- Mullen M. A., Kohut N., Sam M., Blendis L., Singer P. A. Access to adult liver transplantation in Canada: a survey and ethical analysis. CMAJ. 1996 Feb 1;154(3):337–342. [PMC free article] [PubMed] [Google Scholar]
- Nord E., Richardson J., Street A., Kuhse H., Singer P. Maximizing health benefits vs egalitarianism: an Australian survey of health issues. Soc Sci Med. 1995 Nov;41(10):1429–1437. doi: 10.1016/0277-9536(95)00121-m. [DOI] [PubMed] [Google Scholar]
- Novick R. J., Kaye M. P., Patterson G. A., Andréassian B., Klepetko W., Menkis A. H., McKenzie F. N. Redo lung transplantation: a North American-European experience. J Heart Lung Transplant. 1993 Jan-Feb;12(1 Pt 1):5–16. [PubMed] [Google Scholar]
- Olbrisch M. E., Levenson J. L. Psychosocial evaluation of heart transplant candidates: an international survey of process, criteria, and outcomes. J Heart Lung Transplant. 1991 Nov-Dec;10(6):948–955. [PubMed] [Google Scholar]
- Tengs T. O., Adams M. E., Pliskin J. S., Safran D. G., Siegel J. E., Weinstein M. C., Graham J. D. Five-hundred life-saving interventions and their cost-effectiveness. Risk Anal. 1995 Jun;15(3):369–390. doi: 10.1111/j.1539-6924.1995.tb00330.x. [DOI] [PubMed] [Google Scholar]
- Ubel P. A., DeKay M. L., Baron J., Asch D. A. Cost-effectiveness analysis in a setting of budget constraints--is it equitable? N Engl J Med. 1996 May 2;334(18):1174–1177. doi: 10.1056/NEJM199605023341807. [DOI] [PubMed] [Google Scholar]
- Zweibel N. R., Cassel C. K., Karrison T. Public attitudes about the use of chronological age as a criterion for allocating health care resources. Gerontologist. 1993 Feb;33(1):74–80. doi: 10.1093/geront/33.1.74. [DOI] [PubMed] [Google Scholar]
- de Hoyos A. L., Patterson G. A., Maurer J. R., Ramirez J. C., Miller J. D., Winton T. L. Pulmonary transplantation. Early and late results. The Toronto Lung Transplant Group. J Thorac Cardiovasc Surg. 1992 Feb;103(2):295–306. [PubMed] [Google Scholar]