Ethics, Law, and Medical Practice

By Kerry J. Breen; Vernon D. Plueckhahn et al. | Go to book overview

11
ETHICS AND THE ALLOCATION OF HEALTH CARE RESOURCES

Autonomy, beneficence, non-maleficence and justice are four basic principles upon which ethical medical practice is founded (see Chapter 1). In the allocation of health care resources, be it at government, institutional or medical practitioner level, the principle of justice, particularly 'distributive justice', is central. In 1990, the NHMRC in its Discussion Paper on Ethics and Resource Allocation said:

In the allocation of any public resources our concern should be primarily with justice. This involves giving to each person his or her due. In allocating health care resources our concern is largely with distributive justice--to distribute amongst members of the community those benefits and burdens due to them. The basis of distributive justice is the notion of fairness. The most appropriate criterion for a fair distribution of resources would appear to be those of equity and need. More specifically, a just allocation should offer equal treatment for those whose needs are similar. In other Words, each person is entitled to enjoy an appropriate share of the sum total of the resources available according to their need. However, the need which justifies one person's entitlement must be a need which can be fulfilled in a way compatible with fulfilling the similar needs of others.1

Modern society stresses that discrimination between people with the same needs is not morally justifiable. Ethical problems associated with the question of the establishment of priorities in the provision of medical care are pressing relentlessly on the medical profession, the government and society as a whole. While some doctors might prefer to ignore its importance, the ethics of the allocation of health care resources has obvious implications for the entire community, and doctors as knowledgeable members of the community need to understand the issues to participate appropriately in the required decisions. As resources are clearly finite, it is predictable that their allocation will

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