Week 4 Flashcards

Question

Rationing

Answer 1

Resources are limited Demands on the system continually increase This means that clinical need cant be the only deciding factor into how money is spent

Answer 2

Pharmaceutical companies seek to recoup the costs of research and development before the patient on their product expires Many new medications cost more to produce New cellular therapies are very expensive (eg CAR-T therapy) Overall medication costs in hospital have been increasing at ~12% per year. Whereas the NHS budget has only been increasing by around 1% per year

Answer 3

ICU beds are a finite resource in high demand and only occupiable by one patient at a time- therefore a decision to take a patient to ICU potentially prevents another patient subsequently accessing that bed ICU doctors when making the decision about whether or not to accept to patient, follow a first come first serve system- a form of egalitarian distribution as in theory everyone has an equal chance of needing a bed when one is free But they also have mind of the utility of the resource itself - where a finite resource can do most good In normal times if your ICU is full the patient if suitable will be able to be transferred to another ICU nearby to receive the same care Who is suitable: -someone with good chance of recovery -and fairly quickly

Answer 4

During COVID there was the real prospect of ICU saturation that there would be no ICU beds available to transfer to elsewhere The BMA issued ethical guidance arguing that in these circumstances it was permissible to follow a first come first serve policy but if someone subsequently arrived who had a better chance of survival they should be put on the ventilator instead. In effect age was the key discriminator This raises issues: -equalities act -withdrawal of treatment when it would still be in the best interests of the patient -prioritarian reasoning: prioritarians would argue that theres ethical justification in promoting the interests of the young as by definition they have had less opportunity to benefit in life than old

Answer 5

Those who are already disadvantaged then find themselves further disadvantaged Eg saving the life of someone with a chronic condition that decreases QOL will always generate a smaller gain in QALYs then saving the life of a person in perfect health- they’re ‘unlucky twice’

Answer 6

Those who have a rare disease have less chance of an effective treatment being available And a pure utilitarian approach would not justify investment to save such a small number of people

Answer 7

Improved recognition- training for clinicians Internationally coordinated research Review of how cost effectiveness is considered in the case of rare diseases Improve access to international experts Strategic funding of research in rare diseases Orphanet- European network dedicated to orphan drug and rare diseases

Answer 8

Drugs for rare diseases that would not be commercially viable for development Development and trials are subsidised by governments But generally they still pan out very expensive Is it just to have a different threshold for cost per QALY for rare diseases What about costs other than medications Many rare diseases are fatal in early childhood are there arguments here about futility? About prolonging suffering ?

Answer 9

“A just society is a society that if you knew everything about it, you’d be willing to enter it in a random place” John Rawls

Answer 10

Decision and time specific Understand info Retain info Weigh up Communicate decision

Answer 11

Acute/sudden loss of capacity- temporary? Long term loss of capacity Is it recoverable? If so within the time frame to make a decision

Answer 12

Life saving treatment in their immediate best interests dont need consent

Answer 13

Completed by a person to appoint said person to make decisions on their behalf in the event they lose capacity Healthcare or social/welfare or both Must be registered (office of public guardian) and you must see it POA decisions should be considered same as the patient

Answer 14

Legally binding Sets out refusal to future treatment in the event of losing capacity Can be written or verbal For life sustaining treatment it must be written, signed, witnessed and contain statement that says it applies even if the persons life is at risk

Answer 15

Decision taken is least restrictive to persons rights and freedom of action Best interest decisions should take account of: patients prior wishes, patients current wishes, balance risk vs benefit

Answer 16

Can decide whether someone has the mental capacity to make a particular decision for themselves Can appoint a deputy to make ongoing decisions for people who lack mental capacity Can action urgent or emergency applications where a decision must be made on behalf of someone else without delay Can make decisions about a lasting power of attorney or enduring power of attorney and considering any objections to their registration Can make decisions about when someone can be deprived of their liberty under the mental capacity act