Week 7 Organ donation/distributive justice Flashcards
What is justice?
fairness & equity
- resources
- responsibility
- consequences
What is social justice?
how we treat individuals and groups within society with fairness and equity
What are the 3 tenants of social justice in the Canada Health act?
- comprehensiveness - you get what you need
universaility - Available to everyone
- Accessibility - everyone can do/use it
What is distributive justice?
- how we equitably distribute benefits and burdens
- how we compensate those who have been unfairly burdened or harmed
What is the benefit of a socially just society?
reduced health inequalities
What is the foundation of determining fair distribution ?
our values guide the process, weigh risks, benefits, burdens and costs
What are the 4 things that make up the allocation or resource?
Financial resources
Human resources
Time
Medical resources
what is rationing and what are two examples?
a method of allocation
- give to those who benefit the most
- give limited meds to immunocompromised people
- diagnostic equipt to those who don’t have it in the area first
What is Macro-allocation?
to an institution or community
ie) govt to health departments
What is Meso-allocation?
within an institution or community
ie) how many nurses will work on a unit at a given time
What is Micro-allocation?
to individuals
ie) nurse manager distributes patients so that each has 1-2 when short staffed
what are the 5 options available to determine FAIR distribution of resources?
- option 1 - to each person an equal share - egalitarian
- option 2- to each person according to individual need
- option 3- to each person according to effort/social contribution
- option 4- to each person according to merit (meritocracy)
- option 5- to each person according to free-market exchange
What is the problem with option 1- to each person an equal share?
What if someone doesn’t need their share?
ie) everyone gets the same number or bed days. Can you sell the ones you don’t need?
What is the problem with option 2 - to each person according to individual need?
Sometimes people have the same degree of need at the same time so how do you choose?
You then go to egalitarian - like look who has been waiting the longest.
Or use a score to determine if someone is an ICU candidate more than another but also determine if that’s a viable option for them
What is the problem with option 3- each person according to effort/societal contribution?
Does not account for social determinants of health that have acted as barriers
- disadvantaged people or children, people with disabilities would never have a chance to contribute
What is the problem with option 4 - to each person according to merit (meritocracy)?
who decides what “merit” to measure? who decides what “deserves” means?
- what about people who contribute to society like doctors or nurses. should they get before someone else cuz we need them?
What is the problem with option 5- to each person according to free-market exchanges?
people without money are at a disadvantage- they would never have the opportunity to have care
staff go to private clinics because they pay better and then gov’t services decline
In healthcare, which option for distributive justice do we typically use?
according to need
- largest patient # = largest budget
- most ill = first to be seen at ER
- sickest patients- get more of nurses time
What is the framework for resource allocation?
- transparent- everyone knows the rules
- Relevant - the rules are appropriate to the situation
- Reviewable - people can appeal a decision made using the proces
- Written- put down in policy so they are enforceable
What happens if there is no framework for resource allocation that is clear?
Then we just decide in the moment and ship people off to other provinces like during covid.
There is supposed to be public consult + written down
Do we have an ICU Triage protocol?
we do not
What is the ICU Triage protocol?
- process to determine ICU eligibility
- principle of justice
- who would most likely benefit from ICU
What should a triage protocol include?
- transparent- clinical criteria
- relevant criteria
- review process- built in review/appeal of decision
- written/documented - in policy and enforceable
What is Opt-out consent?
You are assumed/deemed/presumed a donor unless you opt out
