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A fine balance needs to be found between caring for individuals and caring for the larger community of which they are a part. Vaccinations, for example, benefit many at the expense of a few. Fluoridation of drinking water and public health measures such as sanitation can also raise social and political issues. Resources have to be rationed at 3 different levels:
- What percentage of the nation’s resources should be spent on healthcare?
- How should this healthcare budget be divided up between the different fields? o Overseen by the Clinical Commissioning Groups, advised by NICE
- Differentiating between patients by individual practitioners- need to use the 4 principles with the greatest focus being on justice, i.e. how to decide that one patient gets treatment over another.
In the case of Infertility Rights: women under 40 are offered 3 cycles of IVF, those between 40 and 42 are offered 1 and those any older are not eligible for any. Although childlessness is a serious problem for those who can’t have children, it is not a disease and so there is an argument it shouldn’t be provided for out of public funds so although about 40% of IVF treatments are funded by the NHS, 60% is privately funded. The Postcode Lottery isn’t fair, with some areas offering it for free and others not, but as it would be extremely expensive (approximately £100,000,000) to provide for all regions, the funds have been allocated to more life-threatening conditions.
Theories of Justice
- Utilitarian Theories – focus on maximising health gain and take into consideration QALY (quality adjusted life years) but this is value laden and so ignores the old and the chronically ill, who may have a lower quality of life. Should this detract from their right to treatment?
- Libertarian Theories – emphasise individual liberty and are implemented in USA, encouraging a free market in healthcare services, including body tissues, organs and babies.
- Egalitarian Theories – believe in equality of distribution unless an unequal distribution would work to everyone’s benefit. This system tries to create a decent minimum, as in the Oregon Health Plan and the criteria are based on feasibility in cost-benefit analysis of treatments.
How to answer questions about resource allocation
A common one is money. Remember that everything costs about 100x more than what you think it’s going to. And you’re always going to have to balance the good of the many vs. the good of the individual and when it’s down to the major governing bodies that have to allocate resources, they use a very utilitarian view and try to help the most people.
Never fall into the trap of saying that somebody deserves treatment more than anybody else (the elderly, the obese, smokers) but say that certain factors such as age or lifestyle choices can cause certain groups of people to go overlooked or, perhaps, be overrepresented at the expense of the care of others. It’s a difficult situation and in this case, justice is the principle most valued.