There are several ethical issues related to allocating scarce health care resources. Different ethical frameworks provide approaches for prioritizing patients, such as maximizing health benefits for the greatest number, or allocating based on principles of fairness and medical need. While it is difficult to satisfy all expectations, transparent use of ethical tools and frameworks can help clinicians and committees make reasoned and justifiable decisions about resource allocation.
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare.
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare.
Community diagnosis is vital in health planning, evaluation and needs assessment, several types of indicators are valid to be used for community diagnosis including Socio-economic, demographics, health system, and living arrangements.
Delivered by Prof Frances Ruane, Chairperson of the Expert Group on Resource Allocation in the Health Sector, Executive Director of the ESRI at the IPHA Annual Meeting 2010.
Community diagnosis is vital in health planning, evaluation and needs assessment, several types of indicators are valid to be used for community diagnosis including Socio-economic, demographics, health system, and living arrangements.
Delivered by Prof Frances Ruane, Chairperson of the Expert Group on Resource Allocation in the Health Sector, Executive Director of the ESRI at the IPHA Annual Meeting 2010.
Resource estimation and allocation happens to be one of the most crucial make/break points for most projects. However, this detail usually gets underestimated by project managers which consequently become evident in their lack of efficiency and effectiveness in the tasks they oversee. This lecture brings out a few techniques (scientific) as to how PMs can easily navigate their way through this difficulty.
3.1 INTRODUCTION
When the health community makes reference to patients having access to care, the reference is
generally limited. The concept of access is too often described as individuals getting to and from
health services and having the ability to pay for the services either by virtue of a third party or
out-of-pocket. We believe access to be much more than this and suggest that a redefinition of
access is long overdue. True access means being able to get to and from health services, having the
ability to pay for the services needed, and getting your needs met once you enter the health system.
This text introduces a framework for assessing the strengths and weaknesses of selective healthcare
systems, and determining if the system is providing true access to health care. The framework is
called “The Eight Factor Model.”
The comparison of health systems is made by utilizing The Eight Factor Model, which was
developed by the authors, and has “true access” as the driving value. As illustrated in Figure 3-1 ,
the model has true access at its core, and eight surrounding factors that are important for health
systems to demonstrate in order to provide that true access. A solid directional arrow from the
factor to the core depicts a system that has demonstrated evidence to support that it is providing
true access. A broken directional arrow from the core to the factor suggests the system is not
providing true access, and much work must be done to achieve it. Table 3-1 (a format for assessing
true access) provides a template for learners to formulate their own opinions about the extent to
which countries discussed in this text provide true access. Table 7 in Chapter 16 , The Eight Factor
Model for True Access, summarizes author observations regarding the extent to which each of the
11 countries discussed in the “Health Care in Industrialized (Developed) Countries and “Health
Care in Developing Countries” sections of this text have addressed true access. This will hopefully
enable the learner to briefly review it against the Eight Factor Model illustrated in Figure 3-1 . Table
7, The Eight Factor Model for True Access, which appears at the end of Chapter 16 (Comparative
health perspectives) should be fully reviewed as the l ...
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Resources for Week 2 HLTH440 from M.U.S.E. My Unique Student Expe.docxronak56
Resources for Week 2 HLTH440 from: M.U.S.E. My Unique Student Experience Registered Trademark CEC 2013. All Rights Reserved.
The Basis for Health Care Ethics
What is Ethics?Ethics is what you believe is right or wrong. It is a moral philosophy that seeks to help the individual distinguish between good and bad as defined by one's culture. Ethics guides individuals and groups in their decisions about health care and other matters. Ethics helps the individual and group set boundaries.
Health care ethics is based on the law, professional codes of ethics, standards of care, and institutional policies and practices (corporate law).
Codes of EthicsCodes of ethics or codes of conduct are lists of standards or guides that provide an ethical framework for practice within a profession. Physicians are bound by the Hippocratic oath, but nursing has its own code of ethics. All health professions have a code of ethics.
It is axiomatic that the practice of health care presents moral and ethical dilemmas, because it deals with human beings and life-altering circumstances.
Health care financing presents broader moral dilemmas in the allocation of scarce resources. The conflict exists between the inherent values, duties, and obligations in caring for patients and the availability of resources to treat them.
The depth or content of a code of ethics is dependent on the type of contact that the health care professional has with a patient.
Ethical Theories
A number of ethical frameworks or theories are used to make decisions in health care and, in general, to set boundaries for expected behavior. The theories are used to determine what is fair or unfair. The following are several ethical frameworks:
Normative ethics: The ethical theory that describes how things ought to be.
Teleological theory: Also known as consequentialist theory, which believes that the best action in any situation is the one that promotes the greatest happiness for the largest number of people. In health care financing, this would fall under the rubric of cost containment by calculating the net benefits verses the consequences.
Utilitarianism: This is Mill’s definition of morality, which is the practical ethics of judgment: What is the greatest good that will benefit the greatest number of people? Medicare falls under this rubric.
Deontological theory: What one should or must do based on the obligations and duties of one’s life. This theory focuses on means, whereas teleological theory focuses on ends.
Virtue ethics: This is the ethics of care as a part of virtue ethics; virtue ethics is a form of normative ethics, which emphasizes the character of the interaction between the health care provider and the patient. This is the opposite of the emphasis on rules or consequences in other moral theories. Health care virtues include compassion, conscientiousness, cooperativeness, discernment, honesty, trustworthiness, truth telling, integrity, kindness, respect, and commitment.
Situational ...
Health ethics is the branch of ethics concerned with the moral principles and values that guide decisions and actions within the health care sector. It encompasses a wide range of ethical issues that arise in the delivery of health care services, such as informed consent, confidentiality, resource allocation, patient autonomy, and end-of-life care.
Health ethics also addresses the ethical implications of medical research and technological advancements in health care. For example, it considers the ethical implications of genetic testing and the use of reproductive technologies, as well as the moral responsibilities of healthcare providers, institutions, and governments.
The principles of health ethics include respect for patient autonomy, non-maleficence (doing no harm), beneficrimination, and beneficrimination. Health care providers are also guided by the principle of beneficrimination, which requires them to make decisions that are in the best interests of their patients, even if this may conflict with their own values or beliefs.
Health ethics serves as an important tool for making informed and moral decisions in health care, and it is critical to ensuring that health care services are delivered in a way that is fair, just, and respectful to all individuals.
1.Write an essay discussing the various causes and solutions for aBenitoSumpter862
1.Write an essay discussing the various causes and solutions for a patient’s inability to pay for medications (prescriptions).
Your response should be at least 200 words in length
2. “Front desk syndrome” is a particularly troublesome aspect of patients visiting their healthcare provider. Write an essay describing this phenomena and methods to prevent or decrease its occurrence.
Your response should be at least 200 words in length.
Inmate Manipulation and Boundaries
Nicole Jones, Dionne Russell, Francisco Villegas, Lupe Silva
University of Phoenix
CPSS/430
Dr. Debra McCoy
May 16, 2022
What to Expect from This Presentation
Summary of manipulation scenario
Development of a plan for how to maintain boundaries in this situation
Possible obstacles in setting and maintaining these boundaries
Identifying ethical and legal consequences to not maintaining boundaries in this situation
Manipulation Scenario
Patricia Wilkes works as a correctional officer at Corcoran California state prison. Corcoran is a high security institution that houses some of the most violent male offenders. Patricia has worked at the institution for four years and has encountered two attacks against her from two separate inmates over a year span. Patricia is freshly returned back to work after being off for a week due to her injuries from her latest attack. The attack involved her being pushed down by an inmate, causing a sprain arm. Feeling vulnerable Patricia became friends with an inmate who witnessed the attack and promised to issue protection if she sneaks in contraband for him. She is conflicted but, because she is afraid; she agrees to do it.
How to Maintain Boundaries in this Situation
How to Maintain Boundaries in this Situation (continued)
How to Maintain Boundaries in this Situation (continued)
Possible Obstacles in Setting and Maintaining these Boundaries
Possible Obstacles in Setting and Maintaining these Boundaries (continued)
Possible Obstacles in Setting and Maintaining these Boundaries (continued)
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation (continued)
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation (continued)
Questions
References
HCA 4303, Comparative Health Systems 1
Course Learning Outcomes for Unit I
Upon completion of this unit, students should be able to:
1. Identify and explain how demographics, such as age and race, impact true access to quality care.
Reading Assignment
Chapter 1: Introduction
Chapter 2: Disparities in Health Care: Race and Age Matters
Unit Lesson
Many Americans find it difficult to even comprehend being denied access to medical care. When we are sick,
we want to see a physician, promptly receive a diagnosis, and procure the necessary treatment that will
restore us to our previous level of health. T ...
1.Write an essay discussing the various causes and solutions for aSantosConleyha
1.Write an essay discussing the various causes and solutions for a patient’s inability to pay for medications (prescriptions).
Your response should be at least 200 words in length
2. “Front desk syndrome” is a particularly troublesome aspect of patients visiting their healthcare provider. Write an essay describing this phenomena and methods to prevent or decrease its occurrence.
Your response should be at least 200 words in length.
Inmate Manipulation and Boundaries
Nicole Jones, Dionne Russell, Francisco Villegas, Lupe Silva
University of Phoenix
CPSS/430
Dr. Debra McCoy
May 16, 2022
What to Expect from This Presentation
Summary of manipulation scenario
Development of a plan for how to maintain boundaries in this situation
Possible obstacles in setting and maintaining these boundaries
Identifying ethical and legal consequences to not maintaining boundaries in this situation
Manipulation Scenario
Patricia Wilkes works as a correctional officer at Corcoran California state prison. Corcoran is a high security institution that houses some of the most violent male offenders. Patricia has worked at the institution for four years and has encountered two attacks against her from two separate inmates over a year span. Patricia is freshly returned back to work after being off for a week due to her injuries from her latest attack. The attack involved her being pushed down by an inmate, causing a sprain arm. Feeling vulnerable Patricia became friends with an inmate who witnessed the attack and promised to issue protection if she sneaks in contraband for him. She is conflicted but, because she is afraid; she agrees to do it.
How to Maintain Boundaries in this Situation
How to Maintain Boundaries in this Situation (continued)
How to Maintain Boundaries in this Situation (continued)
Possible Obstacles in Setting and Maintaining these Boundaries
Possible Obstacles in Setting and Maintaining these Boundaries (continued)
Possible Obstacles in Setting and Maintaining these Boundaries (continued)
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation (continued)
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation (continued)
Questions
References
HCA 4303, Comparative Health Systems 1
Course Learning Outcomes for Unit I
Upon completion of this unit, students should be able to:
1. Identify and explain how demographics, such as age and race, impact true access to quality care.
Reading Assignment
Chapter 1: Introduction
Chapter 2: Disparities in Health Care: Race and Age Matters
Unit Lesson
Many Americans find it difficult to even comprehend being denied access to medical care. When we are sick,
we want to see a physician, promptly receive a diagnosis, and procure the necessary treatment that will
restore us to our previous level of health. T ...
نظرية التطور عند المسلمين (بروفيسور محمد علي البار
ويقدم فيها سردا تاريخيا لنظريات نشأة الخلق وخلق آدم وكيف ان نظرية التطور هي نظرية علمية وليس دينية لكن تم استغلالها لمحاربة الكنيسة
Ethical considerations in research during armed conflicts.pptxDr Ghaiath Hussein
My talk @AUBMC Salim El-Hoss Bioethics Webinar Series. In this webinar, we have discussed the following points:
1- How armed conflicts affect the planning and conduct of research?
2- What is ethically unique about research during armed conflicts?
3- How did my doctoral project approach these ethical issues both at the normative and the empirical levels?
4- What are the lessons learned from the conflicts in the middle east (Sudan, Syria, Yemen, etc.) and how do they differ from the situation in Ukraine?
Acknowledgement: This talk is based on my doctoral thesis (http://etheses.bham.ac.uk/8580/), which was fully funded by Wellcome Trust, UK.
Research or Not Research? This Is Not the Question for Public Health Emergencies
November 17, 2021 @ 4:00 pm - 5:00 pm EST
Speaker:
Ghaiath Hussein, Assistant Professor, Medical Ethics and Law, Trinity College Dublin, Ireland
About this Seminar:
Public health emergencies, whether natural or man-made, local or global, in peacetime or during armed conflicts are always associated with the need to collect data (and sometimes biological samples) about and from those affected by these emergencies. One of the central questions in the relevant literature is whether the activities that involve the collection of data and/or biological samples are considered ‘research’, with the subsequent endeavour to define what ‘research’ is and whether they should be submitted for ethical approval or not. In this seminar, I will argue that this is not the central question when it comes to research/public health/humanitarian ethics. Using the findings of a systematic review on the research conducted in Darfur and findings from a qualitative project that aimed at defining what constitutes ‘research’ in public health emergencies I will, alternatively, present what I refer to as the ‘ethical characterization’ of these research-like activities and how they can be ethically guided.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. 147
By the end of this module, the resident will be able to:
1. Identify the ethical issues related to resource allocation in public
health
2. Present at least one ethical framework for resource allocation
3. Utilize an ethical framework to outline an approach to allocate
resources
What are the ethical issues and principles in resource allocation?
It is almost a fact in health care that there are never enough resources for
everyone. This is true even in the richest countries. There are always health
needs; some health care needs are basic, while other needs can be considered
secondary or tertiary. For example, there is a growing need for body organs,
which makes waiting lists longer and longer for patients with liver or kidney
failure, and for patients who may even need lungs or hearts. Resource
allocation is not only about money; it also includes time allocation to patients,
and allocation of beds or drugs.
Issues related to allocation of resources are faced at both the higher level of
policy setting (the Ministry of Health) and at the bedside level. We will mainly
focus on the latter.
The following are examples of the main ethical principles that are relevant to
this issue:
The principle of (distributive) justice
Patients and the community in general expect the health care system,
represented mainly by clinicians, to be fair. However, the standard of fairness
is usually measured against the patient‟s expectations of the system, which
might be idiosyncratic, rather than realistic. In addition, the health care service
should be provided regardless of gender, race, socioeconomic status, or any
other non-clinical factors.
The principles of non-maleficence and beneficence
Doctors should not do anything that would harm their patients. This includes
providing them with the care needed to avoid this harm (non-maleficence) and
extending their well-being (beneficence). However, these principles do not tell
doctors which patients‟ interests should be given priority when there is more
than one patient in need of a resource.
The patient‟s autonomy
The principle of autonomy indicates that individuals have a right to make
decisions that are related to their own health and bodies, though this right is
4. 148
bound by similar limits given to other individual members of the community. It
could logically be expected that patients (or their families) might want to
“have everything done” to cure their disease.
Different approaches to allocation of resources in health care
There have been many attempts to decide who should get what, i.e., how to
allocate health care resources. These approaches may not (and will not) arrive
at the same conclusions, or the expected “right” answer. Some of these
approaches are presented here, to help you decide which ones to utilize when
facing similar problems related to allocation of scarce resources.
Consequentialist and utility principle approach
The utility principle is about acting to produce the greatest good.
Consequentialism (utilitarianism) considers the right action to be that which
produces the greatest sum of pleasure in the relevant population. This
suggests that the resources available in a health care setting should be used
to provide the greatest good for the greatest number.
Deontological (duty-based) approach
Deontology is duty-based, and suggests that people should act to fulfill their
duties to others, and that acts should always follow a set of maxims (e.g., “Do
not lie”). This approach focuses less on the act‟s consequences.
Cost-effectiveness, quality-adjusted life-years (QALYs) and
disability-adjusted life-years (DALYs)
In addition to being just (fair), distribution of resources needs to be cost-
effective. This means that the allocation maximizes health benefits for the
population served. A cost-effectiveness analysis (CEA) compares the
respective costs and benefits of alternative health intervention measures to
determine their relative efficiency in the production of health. Costs are
measured in monetary terms; benefits are measured in health improvements.
By dividing costs by benefits, one can obtain a cost-to-effectiveness ratio for
each health intervention, and interventions can be ranked by these ratios.
Quality-adjusted life-years (QALYs) are used to combine the two main benefits
of health care: (a) protecting or improving health or health-related quality of
life, and (b) preserving life. Disability-adjusted life-years (DALYs) are a variant
of QALYs in that they measure the losses from disability or premature death; a
CEA will determine which interventions will maximize QALYs or minimize
DALYs (Brock & Wikler, 2006).
Principle-based approach (Principlism)
Principlism is one way of approaching professional deontology. Put simply, it is
based on stating one or more principles from which stem duties. Some
5. 149
examples of these principles include Hippocrates‟ oath (“First, do no harm” or
“Primum non nocere”), the Belmont Report, produced in 1978 (three
principles) and the four principles of beneficence, non-maleficence, respect for
persons, and justice by Beauchamp and Childress. (Beauchamp & Childress,
2008)
Fair process approach (Accountability for reasonableness)
This approach is focused more on the process of allocating resources, rather
than the principles used. In other words, if we cannot agree on what is a fair
distribution, let us at least agree on procedural justice (fair process). For a
“fair process” of resource allocation, Norman Daniels suggested a set of
principles that should be followed in decision making:
Transparency/publicity: information about the processes and bases
of decisions should be made available to the affected population.
Participation: the stakeholders should be involved in the processes
of formulating the objectives and adopting the policies.
Effectiveness/Relevance: states that there must be ways to
translate the other principles into practice relevant to meeting
population health needs fairly.
Appeal: Stakeholders should have a way to appeal policies after they
have been adopted, and processes should be in place that allow
policies and plans to be reviewed and revised.
Resources are not only about medications or equipment, but also include
aspects of time and care. Their importance is tied in with the difficulty of
reaching a definite decision on who should be given what. In turn, this may
lead to a level of dissatisfaction among patients and medical staff. Therefore,
there should be an ethical basis on which you can base your decision about
who should receive what.
There are many ways to achieve a fair allocation of resources, which are
based on a number of ethical considerations, summarized in the following list:
1. CEA: (Effectiveness) - priority given to those most likely to achieve
a good outcome, i.e., medical success
2. Medical Need - priority given to those most in need of medical
intervention, or those considered most helpless or generally neediest
in society (vulnerable groups)
3. Utility - achieving the least morbidity/mortality possible, given the
resources available (maximizing good health/survival with the available
resources)
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4. Immediate Usefulness - priority given to those with special skills
that could be used to serve the common good in the immediate
circumstance
5. General Social Value - priority given to those who are considered by
society to have the greatest social worth (past or future)
6. Principle of Conservation - priority given to those who use
proportionally less resources
7. Responsibility for Dependents - priority given to those who have
primary responsibilities to dependents (parents, nursing home
attendants, etc.)
8. None if not all - no one should be saved if all cannot be saved
9. Queue - priority given on a first-come, first-served basis
10. Random Selection - allocation determined by chance (a lottery, for
example)
11. Ability to Pay - priority given to those who can pay for the resources
12. Merit based - priority given to those who have earned it due to past
actions
The main goal of this module is to help you approach such issues; it provides
different approaches and references that will help you reach decisions on
these issues, and justify those decisions to your colleagues and patients, if
needed. This is an important issue because some clinical staff may experience
moral reservations and frustration. This can happen if they feel they have
failed, and let a patient down by allocating an intervention to a different
patient.
Ethically, we have moral obligations of fairness, utility, and beneficence
towards our patients, who expect us to work in their best interests.
In addition, the resource decisions that sectors make might negatively affect
some patients by delaying or denying their access to a given medication or
intervention. Therefore, it is important to find a way by which clinicians and
other health care providers can justify these decisions, at least ethically.
At the policy level, we might expect significant differences between institutions
that have guidance on how their resources should be allocated and those who
do not. This includes policies related to, for example, organ donation,
admission to ICU, and end-of-life care.
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The Islamic approach to these issues is similar to the Islamic approach to
other ethical issues. It aims at achieving the five main goals of the Sharia,
which is to preserve people‟s religion/faith, souls/bodies, mind, wealth, and
progeny. See Module 2 for more details.
As a clinician or member of an ethics committee, you can use more than one
framework. These frameworks are based on a set of questions that, when
answered, will hopefully help you take the most suitable decisions about
allocating a given resource.
We will present two examples:
The American College of Healthcare Executives (ACHE) framework
It has suggested an 8-step approach:
Step One: Clarify the ethical conflict
Step Two: Identify all of the affected stakeholders and their values
Step Three: Understand the circumstances surrounding the ethical
conflict
Step Four: Identify the ethical perspectives relevant to the conflict
Step Five: Identify different options for action
Step Six: Select among the options
Step Seven: Share and implement the decision
Step Eight: Review the decision to ensure it achieved the desired
goal
The Hamilton Health Sciences (ISSUES) framework
1. Identify issue and decision-making process
2. Study the facts
3. Select reasonable options
4. Understand values & duties
5. Evaluate and justify options
6. Sustain and review the plan
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Figure 0.1 ISSUES Framework
(http://hamiltonhealthsciences.ca/workfiles/CLINICAL_ETHICS/HHSEthicsFramework.pdf)
There are rarely enough health care resources for everyone. At some point,
there will be a need to prioritize the beneficiaries of the service that you
provide in a fair way that fulfills your professional commitments.
1. Different people have different expectations of what the health care
system ought to provide, thus it is hard to make decisions that satisfy
everyone.
2. There are moral and professional commitments related to these
decisions.
3. There are ethical frameworks and tools based on ethical principles
that, if used in a transparent way, may help clinicians and ethics
committees to provide fair resource allocation.
1. Beauchamp TL, Childress JF. Principles of Biomedical Ethics, 6th
edition. 2008
2. Brock D, Wikler D. Ethical Issues in Resource Allocation, Research, and
New Products Development. In: Disease Control Priorities in
Developing Countries. 2nd edition. Jamison D, Breman J, Measham A,
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et al., (eds). Washington (DC): World Bank; 2006. Chapter
14. Available from:
http://www.ncbi.nlm.nih.gov/books/NBK11739/?report=reader
3. Crippen D, Whetstine L. ICU resource allocation: life in the fast lane.
Critical Care 1999;3(4):R47-R51 available from: http://ccforum.com
4. Lasry A, Carter M, Zaric G. S4HARA: System for HIV/AIDS resource
allocation. Cost Effectiveness and Resource Allocation 2008;6(1):7
available from: http://www.resource-allocation.com/content/6/1/7
5. Lippert-Rasmussen K, Lauridsen S. Justice and the allocation of
healthcare resources: should indirect, non-health effects count?
Medicine, Health Care and Philosophy 2010;13(3):237-246 available
from: http://dx.doi.org/10.1007/s11019-010-9240-9