Decisions about resourcing for cancer care
The health care system in Australia is facing a shortage of resources that is mainly dependent on funding shortfalls. The context of scarcity implies that we have to face difficult choices regarding the allocation of these limited resources that we will decide to invest (or not) in a particular area of ??care. In order to better understand the nature of these allocation issues, the first step is to understand that the management of the health system involves three decision-making levels: hospital managers, directors of regional boards and provincial ministers. Secondly, because of the social significance of these decisions, the eminently ethical nature of the issues and the structural complexity of the system (Dauwerse, van der Dam & Abma, 2012 p.693). The Australia health care system is public. As a result, all government resources allocated to health are fully funded by tax revenues. There are, however, several decision-making levels in the allocation of resources. Since these resources are limited, it is interesting to examine the choices made and some of the challenges facing professionals, managers and the government in allocating health resources. It is thus the goal of this paper to answer questions such as: What are the criteria for a good decision on the allocation of resources in health services and social services? What individual or collective rights and responsibilities are we testing? Should children care be allocated more resources? Why? Should elderly be allocated more resources? Why? What ethical principles should guide such decisions? If hospital resources are not enough, how are decisions made about who will receive care and who will be deprived of it, who will benefit from the latest technological advances and the latest drugs, or who will have to wait much longer? long before others get services? This is the ethical question that hospital managers and boards of directors, as well as physicians who make all medical decisions and who are responsible for the care of their patients, must answer.
There is no single ethical framework that can be used to decide whether children or elderly should receive more resource allocation (Yao & MacEntee, 2014 p.10). This is because the idea of access to care in an environment where resources are limited requires one to consider different perspectives. One of the ethical perspectives that should be used is the right-based ethics or deontological ethics. These ethics expects us to follow existing laws, conventions and treaties. From legal perspective, both children and elderly should receive the resources. According to the law, health is fundamental right for everyone and equal access to care. Different declarations and international recommendations associate health care with fundamental rights, such as the Universal Declaration of Human Rights of 1948, in its article 25, which states: Everyone has the right to an adequate standard of living that ensures, as well as to his family, health and well-being. The Additional Protocol to the American Convention on Human Rights in the area of ??Economic, Social and Cultural Rights Article 17 provides that every person has the right to special protection in old age and that States must progressively, provide them with specialized medical assistance. It adds that elderly group is entitled to right to health, to an adequate standard of living, to the prohibition of torture, legal capacity and equality before the law (Reamer, 2013 p.87). The budgetary and financial difficulties of the public power are not extinctive of the rights to health care, nor do they cancel its enforceability and justiciability. However, these economic disadvantages may, in the specific case, prevent or limit the exercise of rights to health, and also prevent the emergence of them, insofar as they come to influence the environments of what is understood as existential minimum. However, resource limitation hinders the fulfillment of existential minimum (Sugiarto, Miwa & Morikawa, 2017 p.37). Scarce resources expect the health care personnel to make hard decision on which of the competing parties should receive preferential treatment or more resources (van der Dam, Molewijk, Widdershoven & Abma, 2014 p.627). This forces us to apply another ethical framework called utilitarian ethics in order to determine who between children and elderly should get more resources. Utilitarian ethics expects us to consider the facts, the parties affected, the consequences and the alternatives.
Optimising health outcomes through health promotion and illness prevention
Concerning the facts, the first thing is to understand the context of the need. This entails asking questions such as what makes children sick? How many children get sick? Can the cause be prevented? It is also important to ask questions such as what causes elderly to get sick? If we consider context, we find that diseases affecting elderly are mainly lifestyle diseases, while those affecting children are infectious diseases. In the past, diseases affecting both children and elderly were mainly infectious. The eighteenth century and the beginning of the industrial era are marked as in previous periods by collective plagues (tuberculosis …), to which are added hunger and misery that reinforce the morbid effects of the disease (Pozgar, 2016 p.113). It is through the progressive control of these epidemics, the fight against contagion and later the appearance of effective products that medicine participates in the construction of the political field (Zwijsen, Niemeijer & Hertogh, 2011 p.421). From this, it is clear that the burden of current diseases is attributable to lifestyle and affects mainly elderly. If children are prone to infectious disease, then the existing healthcare systems have mechanisms for infectious disease. This means that as far as facts are concerned, elderly deserves more resources. But is this the only factor to consider? Definitely no. According to utilitarian theory, decision makers should determine the consequences of doing and not doing a given action and then choose the action that brings more positive benefits (Gautam & Acharya, 2016, p.7). This means that we have to evaluate what will happen when more resources are allocated to the elderly at the expense of children and vice versa.
Children represents potential group of population. The theory demands that these expensive and limited services be used for the greater good of society as a whole. Young people who represent the future have “naturally” priority (Low, Fletcher, Gresham & Brodaty, 2015 p.e3). The scarcity of means requires a sort of sorting, as a necessity in time of war. This is a question of justice: acting in a way that promotes the best interest of the whole of society. If children are not given much attention, they will develop weaker immunities and throughout their life, they may experience recurrent diseases. Elderly, on the other hand, can access most of the social services. Most of them have insurance cover. In addition, since most of the elderly suffer from terminal chronic diseases, even if sophisticated management strategies are implemented, they are likely to die. Their chances of dying are eminent. Children, on the other hand, have higher chances of survival if treated. Children also have longer productive life. From economic perspective, even if more resources are allocated to children, such allocation will result in what is called inefficiency (Li & Tracer, 2017 p.67).
For this school of thought, it is normal to give priority to young people who have “productive” years ahead of them; they are human capital. No doubt, we must not absolve the age but recognize the weakness of the economic viability of the elderly person compared to other slices of life. Three main arguments are made here. Older people make greater use of resources, although they cannot, in turn, benefit society: they receive more than their share. Is there not then injustice?
Priority setting for care of children and elderly in a hospital context
It is therefore quite moral to limit the care to be offered to the elderly. Expenditure restraint strategies that have been in place for a few years cannot counter the rising cost of technological medicine and the aging of the population? (Borella, De Nardi & French 2018 p.67). This school bases its position on the natural order of things: aging is part of life. The very nature of the latter indicates the directions to take: there is a time for everything. We recognize that death is inevitable and that medicine does not have to delay it indefinitely. This approach opposes, among other things, any form of therapeutic relentlessness. Many nurses seem to support this way of seeing things. They are much quicker than doctors to stop the treatments they consider unsuitable for the condition of the sick person. For almost twenty years now, through different volumes and research projects, age should be a criterion for allocating and limiting health care. At the end of a long life that has reached the end of its natural life, the fight against death must no longer characterize medical work; health care for the elderly should be used to relieve suffering, not to prolong life.
Conclusion:
Although children and elderly have the rights to health, in an event where resources are scarce, health care providers will have to choose who between the children and elderly should receive more resources. Based on the utilitarian theory, children deserve more resources because they still have more productive life ahead. However, this is not the absolute solution because some may argue that elderly have contributed to the society for long time and deserves preferential treatment (van der Dam, Abma, Kardol, & Widdershoven, 2012 p.251). Whatever the case, such ethical dilemmas can be addressed subjectively because there is no framework that can offer objective solutions.
References:
Sugiarto, S, Miwa, T, & Morikawa, T 2017, ‘Inclusion of latent constructs in utilitarian resource allocation model for analyzing revenue spending options in congestion charging policy’, Transportation Research Part A: Policy & Practice, vol. 103, pp. 36-53. Available from: 10.1016/j.tra.2017.05.019. [7 September 2018].
Borella, M, De Nardi, M, & French, E 2018, ‘Who Receives Medicaid in Old Age? Rules and Reality’, Fiscal Studies, vol. 39, no. 1, pp. 65-93. Available from: 10.1111/1475-5890.12145. [5 September 2018].
Low, L, Fletcher, J, Gresham, M, & Brodaty, H 2015, ‘Community care for the Elderly: Needs and Service Use Study (CENSUS): Who receives home care packages and what are the outcomes?’, Australasian Journal on Ageing, vol. 34, no. 3, pp. E1-E8. Available from: 10.1111/ajag.12155. [5 September 2018].
Gautam, R, & Acharya, P 2016, ‘Human Resource for Health Migration: An Analysis from the Perspective of Utilitarianism’, Online Journal Of Health Ethics, 12, 1, pp. 1-9, Academic Search Premier, EBSCOhost, viewed 7 September 2018.
van der Dam, S, Molewijk, B, Widdershoven, G, & Abma, T 2014, ‘Ethics support in institutional elderly care: a review of the literature’, Journal Of Medical Ethics, 40, 9, pp. 625-631, MEDLINE, EBSCOhost, viewed 5 September 2018.
Dauwerse, L, van der Dam, S, & Abma, T 2012, ‘Morality in the mundane: specific needs for ethics support in elderly care’, Nursing Ethics, 19, 1, pp. 91-103, MEDLINE, EBSCOhost, viewed 5 September 2018.
van der Dam, S, Abma, TA, Kardol, MM, & Widdershoven, GM 2012, ‘”Here’s my dilemma”. Moral case deliberation as a platform for discussing everyday ethics in elderly care’, Health Care Analysis: HCA: Journal Of Health Philosophy And Policy, vol. 20, no. 3, pp. 250-267. Available from: 10.1007/s10728-011-0185-9. [5 September 2018].
Zwijsen, SA, Niemeijer, AR, & Hertogh, CM 2011, ‘Ethics of using assistive technology in the care for community-dwelling elderly people: an overview of the literature’, Aging & Mental Health, vol. 15, no. 4, pp. 419-427. Available from: 10.1080/13607863.2010.543662. [5 September 2018].
Yao, C, & MacEntee, M 2014, ‘Inequity in oral health care for elderly Canadians: part 2. Causes and ethical considerations’, Journal (Canadian Dental Association), 80, p. e10, MEDLINE, EBSCOhost, viewed 5 September 2018.
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Reamer, F G (2013) Social work values and ethics. New York, Columbia University Press. Available from: https://www.strath.eblib.com/patron/FullRecord.aspx?p=1103415. viewed 5 September 2018.
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Pozgar, GD (2016) Legal and ethical issues for health professionals. Available from: https://r2library.com/Resource/Title/1284036790 [Viewed 5 September 2018].
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Li, M, & Tracer, D P (2017) Interdisciplinary perspectives on fairness, equity, and justice. Available from: https://public.eblib.com/choice/publicfullrecord.aspx?p=5049859 [Viewed 5 September 2018].
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