Medical Services, Scarcity & Ethics

Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

How would you decide who should live or die if you have only so many resources by which to save only so many lives? Do you do it based on age, the type of disease, or something else? This lesson goes over these and other ethical dilemmas when medical services are scarce.

Medical Services

Throughout the world, governments as well as doctors and their patients sometimes face a shortage of medical services or supplies. Even if a person does have access to a doctor, that doctor may not be able to help because resources are scarce. They may not have medical supplies, medication, or surgical equipment to do what needs to be done.

This clearly poses ethical dilemmas. In the field of medicine, it's an issue of bioethics, ethics applied to the biological sciences. Let's explore this topic and how the acquisition and allocation of scarce medical resources may affect decisions as well as patient outcomes.

Acquisition of Resources

Let's meet Dr. Infuso. Dr. Infuso works in the poor, but imaginary, country of Ludo, which has recently been ravaged by war. This war has bankrupted the country. The hospital Dr. Infuso is in charge of has an extremely small budget. He can only afford so many supplies, medication, and technology. What is he to do?

He's got a lot of ethical dilemmas in his head. Does he spend most of his money on medication that can save children from local infectious diseases? But this medication is extremely expensive. This would leave him without enough money to save the adult population from diseases that more commonly affect adults. Are children more important than adults? If you don't save the adults, who takes care of the children in a bankrupt state with no orphanages?

Dr. Infuso needs to figure out another problem. Regardless of age, does he focus his meager budget on supplies and treatments designed for relatively more common diseases that are relatively less deadly, or relatively rare diseases that are more likely to be deadly without treatment? In the former case, more people benefit, but in the latter case people will need the treatment and supplies more so. Whose lives are more important? The very sick few or the not-so-sick many? Isn't everyone's life equally precious?

Allocation of Resources

Once Dr. Infuso has decided upon those ethical and practical questions, he needs to figure out how to allocate scarce medical services and resources. Let's say that his country of Ludo has just been ravaged by an epidemic of Giber, an imaginary viral disease that kills a lot of people without treatment. He has patients arriving from all over Ludo to seek what scarce medical care there is: infants, children, adults, and the elderly. Many are going to die without treatment in this emergency situation.

The ethical dilemma Dr. Infuso faces is who gets the relatively few drugs he has for this disease? How will he decide whose lives will be saved? In such instances, doctors may choose one of many methods to decide upon who gets treated and who doesn't. For example, the triage system can be used. Triage is a word that refers to sorting and classifying people affected by some sort of disaster to determine the relative priority for treatment each should receive.

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