Week 9: The Principle of Justice: Distribution of Scarce Resources Flashcards
Principles of Distribution of Resources: Option 1
To each person an equal share
Everyone gets the same number of hospital bed days as everyone else
An Egalitarian approach
The problem is what to do if someone doesn’t need their share, or when someone needs more than their share
Principles of Distribution of Resources: Option 2
To each person according to need
The sickest person gets the bed
A Utilitarian perspective, often how we allocate health care resources
We may need a secondary criterion when we have multiple people are are equally sick, so we might use an egalitarian approach like drawing names out of a hat to decide between people who could benefit equally
Principles of Distribution of Resources: Option 3
To each person according to effort/ contribution
The person who has worked the hardest or chipped in the most gets the bed
If you’ve made a big donation to the hospital, you might jump to the front of the line
This disadvantages people who have never been able to contribute (eg. children, or people incapable of making a “worthy” contribution)
Principles of Distribution of Resources: Option 4
To each person according to merit
The person who “deserves” it most gets the bed
This could mean that a virtuous person, or a famous person, or someone who could benefit society if they received the care
Who decides what “deserves” means? It is a popularity contest? A measure of the good they have produced in society? Unique skills or training for work essential to keep society functioning?
Principles of Distribution of Resources? Option 5
To each person according to free-market exchanges
People who can pay for it gets the bed
We do this in some areas - eg. paying for an MRI at a private clinic
This puts people without money at a disadvantage, because even if they would benefit from the bed, they do not have the opportunity
In healthcare, we tend to allocate resources according to…
Need
The most critically ill are treated soonest in emergency departments
Nurses spend the most time with their sickest patients
The departments that see the largest numbers of patients receive the largest budgets
Macro-allocation
“to an institution or community” - how a government might decide how much money to give to the health department vs. the education department vs. to fix roads and bridges
Meso-allocation
“within an institution or community” - how a hospital determines how many nurses are working on each unit at a given time
Micro-allocation
Distribution of resources to individuals - how a nurse manager might redistribute patients so that each nurse has 1 or 2 extra when the unit is short-staffed, how a nurse managers their time throughout a shift
Framework for Resource Allocation
Accountability for Reasonableness suggests all resource allocation criteria must be:
- transparent - everyone knows what the rules are
- relevant - the rules are appropriate to the situation
- reviewable - people can appeal a decision made using the process
- written - put down in policy so they are enforceable
ICU triage protocol benefit
This process reflects the principle of justice and would result in the fairest and most equitable allocation of ICU resources by focusing the resources on those they would most likely benefit.
What is the ICU triage protocol?
A triage process for determining which patient would be an ICU candidate:
- would be transparent - setting out clinical criteria so everyone knows how decisions are being made
- must include relevant criteria such as clinical factors and exclude irrelevant or arbitrary criteria
- have built-in opportunities for the decision to be reviewed or appealed
- is documented in policy and enforceable to limit the power of decision-makers to diverge from the pre-set criteria
In 2021, Nova Scotia passed legislation regarding organ donation that…
Anyone 19 and over, who is not exempt, will be considered for organ and tissue donation, unless they opt out
This is called “deemed” or “presumed” consent
The opt-out donation protocol:
- transparent - public awareness campaigns have informed people of the new policy
- relevant - the rules are appropriate for increasing donor organs
- reviewable - people can opt out; no one is compelled to donate
- written - the protocol is now on the public record, to avoid arbitrary exceptions
