Access to Healthcare: Ethics of Distribution.

Question 1

How is resource division decided?

Answer 1

3 layers to consider:
Macro (how overall cake is cut): where money will go- health, education, defence, social care, etc

Midi (how healthcare budget is allocated): Where will money in healthcare go, eg Primary/secondary?

Micro (how clinicians are paid and how much is spent on individual patients), eg who gets the transplant?

Question 2

Allocation can often be ethically difficult. How is allocating made easier?

Answer 2

Beneficence, Non- maleficence, Autonomy and Justice
Justice [distributive] ≡ Equity ≡ Fairness
Human Rights Act has several acts that can be linked to allocation of healthcare:
Article 2 is right to life (refusal to fund treatment because of age)
Other articles inc right to private life, right to marriage and children
Article 14 is prohibition of discrimination (e.g. ageism, sexism)

Question 3

What is the “veil of ignorance?”

Answer 3

A way to find out what a just (fair) system would look like
Go under the “veil of ignorance” ∴ blinding–> know nothing of status, ability, ethnicity, wealth, etc.
∴ fairest society created because can’t fight for our own corner

Question 4

What is the libertarianism free market approach to rationing? What problems arise with it

Answer 4

• A complete free market, state shouldn’t play a role in healthcare, more down to individual people, lots of private spending

Problems:
May exclude poor from medical cover
Process is open to discrimination due to race, genetics, lifestyle, etc
Insurance company bureaucracy

Question 5

Lottery and need approach to rationing?

Answer 5

1- Allocation of resources using a lottery. Everyone treated equally and no discrimination on basis of age, gender, etc.
Problems: Fails to consider individual patient needs, Fails to consider cost effectiveness

2-Need= resouce allocation based on need. Problems: Too subjective how would you define need, cost effectiveness/responsibility not considered

Question 6

Consequentialism approach to rationing?

Answer 6

• Spend the resource in the way that gives maximum benefit to society
• Gives a numerical value of health
• e.g. NICE uses QALY (quality adjusted life year) to assess benefits of potential treatments
• Problems:
  Putting price on life
  Potentially unethical, who decides?
  Discrimination possible
  Ignores need of treatment on basis of cost

Question 7

“Personal responsibility” approach to rationing?

Answer 7

• Allocation on basis of responsibility, choice, and lifestyle, not to the irresponsible
• Incentivises people to behave health consciously
  BUT Doctors may become judgemental and harsh
  Overly moralistic approach?
  Not all choices are free choices e.g. addictions

Question 8

“Social worth” and democratic method of rationing?

Answer 8

Allocate resources based on contribution to society.
Problems:
Danger of discrimination/prejudice/corruption
Who decides?
Ignores need

Democratic approach: allocate resources based on democratic decision making. Problems:
Danger of discrimination
General public lack specialist knowledge
Bizarre choices

Question 9

What is the UK law on rationing resources?

Answer 9

V little on resource allocation; courts don’t like to make resource decisions but will intervene if a decision isn’t transparent, rational, or reasonable
Health and Social Care Act: duty of the state to promote health services but does not need to cater for specific people at every point in time
Rationing decisions may be challenged in courts, cases rarely succeed. Challenges commonly based on:
Irrational or unreasonable rationing decision, e.g. race, age, etc
Procedural impropriety (failure of honesty) in the decision-making process