Allocating Scarce Resources and Alternative Medicine Essay

1. Sympathy Rule: Impartiality rule: â€Å"health care professionals should usually be impartial in helping patients† (p. 189) But the rules used must be appropriate for people with ordinary human sympathies and feelings, example, biases toward friends or relatives. So the rules should allow for some bias – It was okay for Alice to send her aunt in first. Argument for the sympathy rule * The sympathy rule would not permit HC providers to help their relatives/friends in any way they like. It would permit them to give priority to their relatives only in very extreme, life and death situations. * From society’s point of view this rule is okay b/c society values both impartiality and close ties between relatives and friends. The sympathy rule is a kind of compromise between the two. Objection to the sympathy rule * We know from experience that people will already be biased toward their relatives and friends, and will have a tendency to give them priority where possible. * So, to counteract this innate bias, there must be a very strict rule against nepotism. However difficult it may be to be completely impartial as between your mother and a perfect stranger, this is what morality requires of HC professionals. 2. Innocents First Rule: Was Alice justified in sending her innocent aunt in before Terrance who caused the accident by his negligence? â€Å"Patient A, who is innocent and who cannot wait for care, ought to be given priority over patient B, who is known to be at fault for the injury and who also cannot wait, other things equal.† (p. 206) Third Party Interests 1) Childless person vs. parent of young child (dependents case) 2) Drunk vs. doctor (the public good case) 3) Person with highly infectious disease vs. person without infectious disease (the innocent threat case) 3. Public Interest Rule â€Å"Where the public interest is great enough, a patient may be given priority over those who came earlier.† (p. 208) Example, treat the Pope or the Prime Minister before the ordinary person. Discussions: 1. My answer to your question is this: No, it is not ethical to use non medical â€Å"social worth† factors to favor one patient over another. The use of such a criteria to choose between candidates for scarce medical resources can be critiqued both from Kantian and Utilitarian perspectives. I believe the most basic and powerful objection to â€Å"social worth† is that such a criteria reduces patients to their potential for maximizing social benefit. Kantian ethics argue that people should never be treated merely as a means to an end. By selecting between patients based solely on their potential contribution to society, they are being reduced to merely a means of achieving the most possible social good. They are not regarded as people with basic intrinsic value that goes beyond their ability to contribute to society. Any patient that does not have the ability to contribute much to society, because they are elderly, mental, or physically handicapped, automatically is unfairly at a disadvantage. On the face of it, Utilitarianism would seem to favor the use of such a criteria. Choosing people to save based on their potential future contribution would seem to produce the most net benefit. However, the physican/patient relationship would suffer greatly if patients felt that their physicians were continually looking past their personal welfare to the potential for social benefit. Distrust and suspicion would result if patients perceive that physicians were making treatment decisions based on their potential social value. Thus, over a longer period of time, the eventual erosion of the physician/patient relationship could result in less net benefit for society, a result not favored by Utilitarianism. Additionally, there are a host of other practical difficulties with appalling a â€Å"social worth† criteria. Use of such a criteria would require some type of ranking of respective social worth. How does a professional athlete rank against a priest, or an insurance salesman, or a physician. How much should patients’ personal life be involved in selection decisions? Given the pluralism of our society, development of such a list is nearly impossible. And even assuming that such a list could be compiled, whose ideas of social value should we use to make the list? Inevitably, personal bias would influence the ranking of â€Å"social worth†. Ultimatley, the use of medical factors, such as need, amount of resources required, and potential for success, should be used for patient selection, not non mendical â€Å"social worth† criteria. 2. As a physician for 30 years, practicing medicine from a perspective of â€Å"hearing the story† of the person, trying to ascertain the depth of their understanding, what motivates them to live, go on, do the unfinished, resolve those difficult relationships, be productive, make a difference, I find that those patients who have had transplants as adults have risen above the flat line of their lives and choose to see life as something to be lived and not something to be chased. â€Å"Social worth† has the unfortunate connotation of value, of something to be contributed, something that inherently gives a sense of future. We the elders decide who and again unfortunately are imperfect yet our decisions are irreversible. Committees are convenient because the decisions take on a vote situation based on the facts of the particular case. Sometimes I think that we do too much cerebrating and not enough feeling and deciding from the heart. The heart knows, where the brain has too much debris and stereotype to render fair decisions in who gets what organ. The system is flawed because we try to make sense out of something that exceeds our understanding and we forget what our hearts are telling us.