Ethics of Rationing Flashcards
What is rationing?
Fair distribution of resources that are scarce
When does rationing happen?
When things are scarce
What is an example of rationing in the UK?
Covid-19
How many ICU ventilators does the UK possess?
30 per 100,000
What were rationing concerns in the pandemic? (6)
- PPE
- Ventilators
- Dialysis
- Testing and vaccines
- Displaced activity e.g. screening, surgery
- Elective waiting lists
What did covid-19 teach us about rationing? (2)
- Means of fair distribution of things that are scarce
- Should be planned for
What are the three certainties in life?
- Death
- Taxes
- Scarcity of resources
What are the causes of scarcity in healthcare? (4)
- Advances in medical technology
- Demographic trends - ‘greying population’
- Budget restrictions
- Public expectations
Before the NHS, what was healthcare rationed by?
Price
Who rations healthcare?
Central government decides funding for NHS
Who allocates the NHS budget? (2)
- 42 integrated care systems
- On the basis of need
Who rations patient access to care? (2)
- Doctors
- Other allied healthcare professionals
Who are primary rationing agents?
Doctors
How should healthcare be rationed? (4)
- Hippocratic oath
- Lasagna Oath (1964)
- World Medical Association codes of ethics
- CMC
What is the Hippocratic tradition?
Maximising the benefits of care for the individual patient in your care
What is the economic perspective?
Consider both costs and benefits of treatment choices (including doing nothing)
What are the principles of rationing healthcare? (3)
- Ability to pay
- Need or benefit
- Social values
What do the NHS ration by?
Need
What is a need for medical care?
A need for care exists when there is an effective and acceptable treatment for cure
What did NICE originally stand for?
National Institute for Cost Effectiveness
What does NICE stand for now?
National Institute for Health and Care Excellence
What is the role of NICE?
Explicit device for rationing healthcare
What is the cut off for cost of QALY?
£20,000-£30,000
Who argued age is an appropriate criterion for rationing? (2)
- Callahan - for longer life
- Williams - fair innings approach
