Hi Pat,

There is a similar question about rationing healthcare already on RG. I responded to that question in detail so won't belabor the point again here. I will just say that my feeling is that the decision should be based upon what allocation of limited health care resources will prove to be most beneficial to society in the long-run.

In most societies, it would seem wise to prioritize providing adequate health care to the young (infants through at least age 15) where preventative steps can be taken to ward off those diseases and life choices that lead to obesity; diabetes; heart disease. Moreover, education is necessary to prevent sexually transmitted diseases and addiction to substances such as narcotics, alcohol, prescribed pain killers, and mood enhancers.

The nature of later-onset diseases seems to indicate that they often are the result of a lifetime of bad choices. At any rate, they are expensive to treat and hard to cure in that this requires the patient to break long-standing habits. Thus, in making health care allocations, education should be considered as such an allocation. I am thinking about teaching children the value of active lifestyles and actually providing easy access through schools to healthy cafeteria diets, as well as building schools that have adequate physical space on campus for indoor and outdoor physical activities. Physical education then would return as part of the educational program, which is not the case in many urban areas where real estate is expensive and thus the playgrounds continue to shrink with more physical space being devoted to buildings in which sedentary activity (like computer instruction) takes place.

Gwen

This is an important question and a very difficult one to answer.  The first step is to help people understand that medical rationing is necessary.  Many are simply unaware of the urgency of this moral problem, or worse some believe it is the creation of elites, particularly in government and the medical insurance industry, and that therefore it is not a real matter of concern.

Rationing is already occurring in modern hospitals as well as in refugee camps.  Unfortunately, it is not always recognized as rationing, and it takes place on a "case by case" basis in the absence of a comprehensive and principled approach.

Rationing is likely to be addressed within nation states and other political units, before approaches are discussed which connect rationing to the unequal distribution of medical resources worldwide, and thus before inter- or multi-national approaches receive the attention of policy makers.

Medical rationing must begin with an examination of the conflicting moral values relevant to it.  It appears that rationing is a question of distributive justice.  The conception of distributive justice, at the least, provides a moral framework for starting to make policy proposals.  Ultimately, such policy proposals will need consistent with the requirements of "public reason".

Pat

John Rawls' Theory of Justice is a masterpiece of liberal theory regarding distribution and there are literally hundreds of articles about his theory. Start there!  Relative to bioethics Beauchamp and Childdress' Bioethics is a great text for getting you up to speed on this big issue. A more conservative approach can be found in Englehardt's Foundations  of Bioethics.  These three will give you a great sense of how large the problem is .

Most hospital emergency rooms deal with this on a triage basis and tend toward taking care of seriously ill patients on a "first come first served basis"  This is basically a lottery approach to distribution but looks really bad if you do not adequately fund the ER or if your patient population is so large and so ill that the concept of "minimally  decent" becomes totally unworkable.  

Try to narrow your focus to a question like "how do you define minimally decent funding for an ER" in a poor part of a city.  You will find that defining "minimally decent" is brutally difficult. 

Try taking a look at a technological approach to distribution. In this arena you eliminate the human providers and replace them with data gatherers  connected to IBM's Watson.  Watson can diagnose better than most docs and he can monitor ongoing care better than most nurses and he can manage millions of patients at one time.   It feels a little inhumane but inhumane care is better than no care and subsequent death. This might meet our budget requirements.

Good luck

Brendan

I like taking this to the limit, to the absurd, many speak about QALY cost, and a limit for cost-effectiveness for it, some publications set at around $90'000, this is what they say, but I ignore what they actually do.

The current technology allows for an isolated brain to be kept alive, this was done many decades ago with a monkey bran, which showed an electrical response to things as making rattle noises in the nearby (Science et Vie: 'Experience hallucinante un cerveau isolé conservé vivant'), imagine somebody has a disseminated cancer, with no hope for cure, and a short life span ahead, but head is intact, so, head could be cut, and put in an artificial heart-lung-kidney-liver machine, with IV feeding, as long at the brain is alive. Who would accept this, and who will pay the expenses?

Something similar can be watched in the movie by Malcolm McDowell, 'O lucky man!', were he spend most revenues from Stanley Kubrick's  'A Clockwork Orange',