Chapter  16: The Allocation of Resources: Scarcity and Triage

Section 3. Presentation of Issues.
Outline for Chapter 10 :

Munson, Ronald. INTERVENTION AND REFLECTION . 6th ED.,Belmont, California: Wadsworth Publishing Company, 2000.

 

ALLOCATION OF SCARCE MEDICAL RESOURCES

PRESENTATION OF ISSUES SUMMARY- Summary by James Rowe, QCC, 2005 

How does one properly ration a limited supply of life-saving drugs? How does one regulate and control the flow of organs? How does one assure that in attempting to aid the scarcity of certain medical resources people aren’t in danger of losing their rights? All these and more are issues which may be conceived as being part of the category of Medical Scarcity.

            The above mentioned issues, as well as others, have immense societal ramifications which can truly impact how we care for many of our sick. However, as the nature of some of these matters which can be lumped under this category are undeniably controversial, such as whether or not we ought to exploit fetal stem cells for their medicinal properties, or whether or not it is legitimate to become pregnant simply to have that child be a potential donor to another family member for bone marrow, or perhaps even organ, donation, policy formation requires extensive considerations. Accordingly, the ethical dilemmas which can arise from cases revolving around such controversies can become difficult, if not impossible, to solve in a manner which manages to reach a compromise which satisfies all, specifically those who are most passionately involved in the subject. A person such as celebrity Michael J. Fox, a sufferer from Parkinson’s disease, may be properly considered to be passionately for the possibilities that his disease, as well as others, may be cured through the aforementioned controversial process of using fetal stem cells, with those who support a fetal right to life being equally as passionate as regards the right for those babies to not be sacrificed even if they could help those people.   

            As an almost ethical analogy to the Second Law of Thermodynamics – a law which essentially states that one cannot cheat the universe into working for one without sacrificing an equal amount of energy, that if one wants a candle to burn for ten days, one must have ten day’s worth of candle, not nine – anything which is capable of producing great change requires equal, if not greater, consideration in order to employ it in the bet manner possible. Taking this into consideration, it ought to neither be surprising nor discouraging that these matters are specifically controversial and require consideration to a great extent.

READ: SLMR-Allocation

READ: Donations Difficult Choice

READ : Transplant Turmoil

CASE PRESENTATION: Acquiring and Allocating Transplant Organs

I. Current Law and Policy

a. disposal-burial, cremation, sea, cryogenic suspension

b. autopsy

c. medical education

d. research

e. therapy -transplantation

II. Problems with Current Voluntary System

a. insufficient cadaver resources

b. voluntary system-difficult to operate

c. Costs

III. Interests Involved

the individual has an interest while alive in the disposition of the body. Interests that include aesthetic, ethnic, religious considerations

the family has an interest in the disposition of the body. Interests that include aesthetic, ethnic, religious considerations

the state has an interest in the dead body in determining the exact cause of death, particularly in cases of suicide . homicide or contagious disease( and workmen compensation cases).

the state has an interest in the dead body in obtaining sufficient cadaver resources for medical education, dental education and funeral director training.

the state has an interest in the dead body for obtaining cadaver resources for medical therapy, including transplantation.

In the event of a conflict among the interests, the state's interests take precedence!

IV. Proposals to increase the number of organs available

a. Change the law

i. Voluntary System, UAGC (1968)

ii. Required Decision / Response (by 18 ) Required Request

iii. Presumed Consent - removal unless there are objections

READ: Presumed Consent

iv. Modified Presumed Consent -removal without disfigurement

iv. Routine Salvaging - no consent needed, no consultation

b. Use anencephalic neo-nates -Loma Linda Medical Center, CA

c. Non-Heart Beating Cadaver Donors NHBCD-Univ. Pittsburgh

d. Organ Protection Prior to Removal / Death

e. Incentive Programs

i. tax breaks

ii. Preferential lists

family members of donor

citizens first policy,permanent residents, legal aliens

other

f. Commercialization-

Buy and Sell Organs and Dead Bodies

READ Paying for Parts

Provide funds to cover burial costs only

Cover the removal costs

g. Accept Black Market materials, organs, etc.

Chinese Organs for sale- Theresa Walling(NCC, 2009)

Chinese organs for sale
http://www.theepochtimes.com/news/8-3-18/67683.html
http://www.news.com.au/story/0,23599,21152231-1702,00.html
http://sunsite.berkeley.edu/biotech/organswatch/pages/cannibalism.html
  
Bodies corpse origins are murky
http://www.nytimes.com/2008/05/30/nyregion/30bodies.html

h. Trans-Species Transplants

i. Capital punishment/donor policy

 

j. Physician Assisted Suicide/donor

k. Living donors

l. Use of Neo-Morts/body factories/warm cadavers/bio-emporiums

bodies in an irreversible coma with no nervous system activity sustained partially by machinery for preservation of organs

i. medical education

ii. medical training

iii. medical experimentation

iv. storage

v. harvesting- tissues, blood, hormones, organs

vi. artificial wombs, incubators

Should neomorts exist at all? If so how should it be determined that a body becomes a neomort? Are there to be any limitations on the use of neomorts? Would the next of kin have any rights with regard to the neomort?

What would it do to the human community if it were to create large numbers of neomorts?

 

 

Organ Allocation:

United Network for Organ Sharing ( UNOS)

Waiting list / eligibility / priority

How best to distribute the scarce resource?

greatest need within the region???

Massachusetts Task Force on Organ Transplantation

1. to those who can benefit from it in terms of probability of living for a significant period of time with a reasonable prospect for rehabilitation

2. decisions should NOT be based on Social Worth Criteria

3. Age is relevant to life expectancy and prospects for rehabilitation

4. final selection under scarcity conditions should be made by some random process (lottery or first come first served basis)

5. Transplants provided within the region regardless of ability to pay. Transplants to those who reside outside the region must be bases on ability to pay.

PROCESSES FOR ALLOCATION OPTIONS:

Social Worth Criteria

Chance / Lottery

Social Worth with chance

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Vaccination Decisions: Who gets what?

READ: Smallpox Strategies

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ETHICAL THEORIES:  re distribution of scarce resources

Utilitarian- the calculus of utilities considers social worth and benefits to society.

Kant - All would be equal and none be used for the benefit of others. Random Selection Method respects each person as being of equal value.

Ross - A duty to protect and preserve our health. Equal value and duty to risk being in a lottery to gain health.

Rawls- benefits must be of value to ALL and open to ALL. Therefore no use of social worth criteria.

Natural Law- Similar to Kant and Ross.

NLT is not opposed to what is not natural.  NLT is in support of what supports natural LAWS, e.g., here the law would be the

Law of Survival! There is a natural drive in all mammals to survive.   Therefore according to NLT organ transplant is morally correct.  According to NLT setting a system where those with greater wealth would have more opportunity for life is not morally correct.

 

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© Copyright Philip A. Pecorino 2002. All Rights reserved.

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