In this particular case, Janet Green is in urgent need of a dialysis machine, as she is experiencing acute kidney failure. After seeking admission to two nearby hospitals, the patient was denied treatment due to a shortage of dialysis machines. The hospitals have implemented “first come, first serve” policies for the machines, rather than analyzing the specific patient’s need for treatment and their unique situation. This simplistic, egalitarian policy avoids necessary discussions concerning the patient’s specific condition. It is imperative to analyze principals of distributive justice to reach an ethical conclusion concerning the allocation of scare medical resources.
Distributive justice is the “fair, equitable, and appropriate allocation of benefits and burdens determined by norms that structure the terms of social cooperation” (Beauchamp and Childress, 250). As demand for certain medical treatments exceeds the existing supply, it is necessary to determine a fair process to allocate resources. In my opinion, the hospitals’ existing “first come, first serve” policy is not appropriate, as it fails to maximize social utility. In other words, I believe that the policies should create the most good for the greatest number of people. Therefore, a utilitarian perspective should be utilized to reevaluate and revise the hospitals’ existing policies.
It is imperative to define what specific benefit or function to maximize when applying the theory of utilitarianism. Essentially, physicians and medical personnel must determine which patient will receive the most benefit from the treatment. Specifically, one must consider medical criteria that include likelihood of benefit, urgency of need, change in quality of life, and duration of benefit (American Medical Association). This particular criterion will help patients with the utmost medical need, while offering the best possible outcome by evaluating an individual’s future quality of life.
In my opinion, it is precarious to maximize functions that stray outside the realm of medicine, as this practice may favor specific patient populations. Specifically, non-medical criteria including ability to pay, social worth, and patient contribution to illness may place vulnerable, low-income populations at increased risk (American Medical Association, 228). A strong focus on non-medical factors is rather insensitive, as it places a high burden on the individual. Additionally, the practice neglects the idea that individuals can turn their lives around, and make changes that will increase their social worth.
As a counterargument to using medical criteria under utilitarianism, one may state that this approach fails to capture equality of persons (Persad, 427). In other words, this practice “neglects the importance of fair distribution” (Persad, 429). Essentially, it is rather difficult to determine optimal principals for resource allocation, as each diverse policy presents new, complex issues. However, I argue that focusing on maximizing future benefits to certain patients will create the greatest good across society. The process and utilization of medical criteria favors individuals with the highest risk, and who will receive the greatest benefit from treatment.
The hospital’s current policy may be fair and easy to quantify, yet it is highly insufficient. The policy does not consider the relevant differences that exist between patients, which may hinder the hospital’s ability to allocate resources in an efficient manner. Additionally, the “first come, first serve” model may be detrimental, as it favors individuals who are well informed, wealthy, and who may travel faster (Persad, 424). Therefore, vulnerable, low socioeconomic patients may not have a fair chance at receiving care.
WORKS CITED:
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2001. Print.
Persad, Govind, Alan Wertheimer, and Ezekiel J. Emanuel. “Principles for Allocation of Scarce Medical Interventions.” The Lancet 373.9661 (2009): 423-31. Web.
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well And Good: A Case Study Approach to Health Care Ethics. N.p.: Broadview, 2014. Print.
Virtual Mentor. “AMA Code of Medical Ethics’ Opinions on Allocating Medical Resources.” American Medical Association 13.4 (2011): 228-29. Web.
I agree that the hospital should change their first come, first serve policy. It does not take into consideration individuals’ conditions as one person’s condition could be worse than another’s who is being treated. Ralph Puthota explained additional reasons why it is essentially unfair to have the first come, first serve policy: For one it can be argued that these are important medical resources and therefore should be distributed to those in need of it, not simply to those who are in line for it. Many of these individuals may not necessarily need them but simply want them. Medical resources should be treated with a higher regard, it is not a materialistic want, such as an iPod and for some it can be matter of life and death. The question of autonomy also came about in the form of challenging a person’s right to a limited resource simply because they were in line first. The moral and utilitarian thing to do in this case would be to honor a person’s need for a resource first before their want (Puthota).
I completely agree with Mr. Puthota as it should be based on necessity and not on an unwarranted want.
Morgan McKnight
Works Cited:
Puthota, Ralph. “Medical Ethics PHIL 148 @ Binghamton University, Sum 11.” Medical Ethics. Binghamton University, n.d. Web. 05 Apr. 2017.
I believe the “first come, first serve” policy should be modified upon consideration of one’s condition. In this scenario, one’s condition should be judged by the medical care staff for its severity. how sick people are and setting priority for who goes to be seen first. It might seem to be a little bit unfair, but the medical condition should not first-come, first-served; in this scenario, Janet Green is in need for urgent care, and she should be treated once the physician gave the assessment of her sickness level and urgency level.
Hi Marianna!
I really enjoyed reading your post on “Case 8.1: Dialysis Machine Shortages: Who Shall Live?”. While I agree that the hospital’s first come, first serve policy is frustrating, eliminating the procedure all together also puts us in a sticky situation. For Janet, getting access to the care she needs will save her life, but without it she will die. Is it fair for Janet to “cut the line” since she is in danger of dying as opposed to other patients who might be in less dire situations? If so, who makes that decision? At least by having the first come, first serve policy, everyone waits for their turn. However, not everyone can hold on long enough for treatment before their time runs out.
An article on the United Network for Organ Sharing explained how the they previously distributed organs solely in an egalitarian basis, but that a policy change started prioritizing allocation of organs to pediatric patients. An index was created that ranked the quality of the donated kidneys and how long they were expected to last after the transplant. Kidney recipients were also given a number indicating the projected life expectancy after the transplant. This system prioritized younger recipients as opposed to the first come, first serve basis. While this seems like a smart plan, if this were utilized in the hospitals, older patients would be passed over every time in an attempt to help the younger generations. Is it just to skip over patients who have lived a long time in an attempt to save those who have yet to experience their life?
Works Cited:
Madwar, Samia. “United States Officials Propose Further Retreat From First-Come, First-Served Organ Donation.” CMAJ (2011): n. pag. Web.
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well And Good: A Case Study Approach to Health Care Ethics. N.p.: Broadview, 2014. Print.
Hi Rylee,
Your question at the end of your comment is intriguing in that it first causes one to look at the very utilitarian viewpoint of the issue in that a younger person would, essentially, get more use and contribute more to society if given the opportunity to live with a kidney transplant. I do not think, however, that it is right to skip over older patients to give organs to younger ones. If this becomes the system, a vulnerable population (the elderly) is highly discriminated against and provides bases of justification for discrimination against other vulnerable populations. Because of the grounds and dangerous precedent it sets, however utilitarian or logical it would be to give the kidneys to younger children, I think there should be a list prioritizing severity and condition over other age factors. Maybe a better system to address this issue would be to give the option of altruism to the elderly patient. If a kidney going to an older person could also go to a child in need, the elderly patient would be able able to direct the kidney to the child in need. What do you think about this idea, and could it be coercive or considered discriminatory in itself?
Thanks,
Elisabeth Crusey
Satel, Sally. “Supply, Demand, and Kidney Transplants.” Policy Review. Hoover Institution at Stanford University, 30 July 2007. Web. 17 Apr. 2017. .