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JUSTICE & RESOURCES

JUSTICE

Justice is in its broadest sense about equality and fairness.

Allocation of medical resources must be fair and according to need.

_ Physicians should not make decisions regarding individuals based upon societal needs

TYPES Distributive justice

Legal justice  Rights based justice

DISTRIBUTIVE JUSTICE

fair distribution of limited resources among members of society i.e. fair healthcare rationing.

LEGAL JUSTICE

Legal justiceapplication of legislation by a judge, magistrate or a supreme court of a country or state, with the objective of protecting victims/patients and punishing/re-habilitating the perpetrators who have broken the law.

RIGHTS BASED JUSTICE

Rights based justice respect of people's rights rather than the application of law. These social rights relate to our society’s belief that every individual and group is entitled to fair and equal rights and participation in social, educational, health and economic opportunities.

TYPES Distributive justice fair distribution of limited resources among members of

society i.e. fair healthcare rationing.

Legal justice application of legislation by a judge, magistrate or a

supreme court of a country or state, with the objective of protecting victims/patients and punishing/re-habilitating the perpetrators who have broken the law.

Rights based justice respect of people's rights rather than the application of law. These social rights relate to our society’s belief that every

individual and group is entitled to fair and equal rights and participation in social, educational, health and economic opportunities.

In fact, our society uses a variety of factors as a criteria for distributive justice, including the following:

to each person an equal share to each person according to need to each person according to effort to each person according to contribution to each person according to merit to each person according to free-market

exchanges

RESOURCES

RESOURCES Full measure of service and devotion by

Physician

" In the Principles of Ethics of the American Medical Association’’

SCARCITY OF RESOURCESsuch as: Equipment, Beds, Drugs, Time or Excessive numbers of persons in need make it difficult.

Decisions for painful tradeoffs in a fair and compassionate manner.

WHAT RULES GUIDE RATIONING DECISIONS?

“rationing” decision must be made. needed thing or procedure is in short supply to those who

need it & by fair distribution.

The reasons for shortage can be many. E.g: there are many more patients with end stage cardiac

disease or liver disease than there are cadaver organs available;

expensive equipment( lacking) beds may be limited; costly medicine; few skilled personnelUnavailable insurance coverage.More dialysis patients than machinesMany bioethicists argued that a lottery or a "first-come,

first-served" , “serious need” criteria would have been more equitable and ethically justifiable.

ARE THERE ETHICAL CRITERIA FOR MAKING TRIAGE DECISIONS?

Triage (which means "choice" or "selection") is a disaster or in the crowded emergency department of an urban hospital.

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.

SECOND SORT OF TRIAGE "UTILITARIAN RULE" GOVERNS MEDICINE: This rule is justified only because of the

clear necessity of general public welfare in a crisis.

second sort of triage is indicated in disasters, such as earthquakes, or in military action.

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

WHAT ABOUT "MACRO-ALLOCATION" CONCERNS?

to give priority to one patient over another.

Many of these reasons for shortage are the result of deliberate decisions to ration.

The practical ethical question is: can a fair and just allocation be actually implemented in a particular social, economic and medical climate?

CAN WE ETHICALLY QUALIFY A "RIGHT TO HEALTH CARE"?

Several ethical theories have been elaborated to formulate criteria for fair and just distribution and to examine the arguments for a "right to health care.“

At present, little agreement exists on any of these issues. Ideally, all persons should have access to a "decent minimum" of health care necessary to sustain life, prevent illness, relieve distress and disability,

so that, in the words of one bioethicist, "each person may enjoy his or her fair share of the normal opportunity range for individuals in his or her society

http://www.gmc-uk.org/guidance/case_studies.asp

Debates over this issue have been lengthy and serious. Many policy proposals have been considered: some implemented and others rejected. However, in the systems of managed health care now so common in American medicine, the question of fair and just allocation of resources must be raised and the various policies and criteria for allocating resources must be reviewed for their fairness and equitability.

Some specific examples of public policy in devising an allocation system concentrate on the criteria of efficiency and cost-effectiveness. The state of Oregon is unique in having such a system for its Medicaid patients: a long list of medical procedures, ranked in terms of their cost/benefit ratio, determines the reimbursement policy. Even with such a system, ethical criteria must also be considered: what is to be done if life-saving and life-sustaining interventions rank low on cost-effectiveness? Is it ethical to omit the rescue of a person from death because their rescue by, say, bone marrow transplantation is less cost-effective than some preventive measures? How is cost-effectiveness to be applied to persons with shorter natural life expectancy, such as the elderly? These questions are not easily answered but they must be consistently raised whenever allocation systems are proposed. Some forms of allocation are obviously unethical in any society that values justice.

For example, making the ability to pay the only way of obtaining medical care or distributing medical resources to the friends or political colleagues of those in power. Many other problems are less obviously unethical but still need to be evaluated and debated

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