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Allocating Limited Health Care Resources: The Ethical Issues

Allocating Limited Health Care Resources: The Ethical Issues. Leslie Meltzer Henry, JD, MSc, PhD(c) Assistant Professor, University of Maryland School of Law. Who Should Receive Scarce Resources When Not All Can?. Historical Examples of Shortages Penicillin on the warfront during WWII

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Allocating Limited Health Care Resources: The Ethical Issues

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  1. Allocating Limited Health Care Resources: The Ethical Issues Leslie Meltzer Henry, JD, MSc, PhD(c) Assistant Professor, University of Maryland School of Law

  2. Who Should Receive Scarce Resources When Not All Can? Historical Examples of Shortages • Penicillin on the warfront during WWII • Food shortages on the home front during WWII • Dialysis machines in the 1960s • Gasoline during WWII and again during the 1970s • Flu vaccine in 2004

  3. Allocation Criteria Social value criteria. Allocation decisions are based on people’s value to society. People who are likely to be valuable to society typically receive preference. Impartial criteria. Allocationdecisions are made randomly from among eligible candidates. There are two ways to select randomly: First-come, first-served systems distribute scarce goods in the order that people line-up for them. Lottery systems distribute scarce goods by chance, usually through a random lottery draw.

  4. The Seattle “God-Squad” Shana Alexander, LIFE Magazine, Nov. 9, 1962.

  5. Allocation Criteria (continued) Medical criteria. Allocation decisions are based on strictly medical factors, including the urgency of the patient’s medical situation, the likelihood that the patient will receive medical benefit, the length of that benefit, and the quality of that benefit. Sociomedical criteria. Allocation decisions arebased onsocialfactors that are believed to maximize improved medical outcomes, such as younger age, psychological stability, and the presence of a support system. Personal criteria. Allocation decisions arebased on personal decisions. Examples include a person’s interest in receiving care, their demonstrated responsible behavior, and their ability to pay.

  6. Who Should Receive Scarce Resources When Not All Can? Modern and Future Examples of Shortages • Organs for transplantation • Health care • Respirators and ICU beds during disasters or instances of bioterrorism • Flu vaccines, both seasonal and pandemic

  7. Case Study: The Possible Shortage of a Vaccine Against H1N1 (Swine Flu) On June 11, 2009, the World Health Organization declared H1N1 as the first pandemic flu in 41 years.

  8. The Spread of H1N1

  9. Allocating the Flu Vaccine During Shortages: The Ethical Questions • Who Should Receive the Vaccine First? • The most vulnerable? • Key health personnel? • Key infrastructure personnel? • Public leaders? • Financial leaders? • Others? • What Criteria Should Guide Our Decisions? • Impartial criteria • Social value criteria • Medical criteria • Sociomedical criteria • Personal criteria

  10. Department of Homeland Security’s Rationing Plan

  11. * Acknowledgements: I am grateful to Jennifer Cohen for her assistance in the preparation of these slides.

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