nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Saturday, April 24, 2010

Rational Rationing: Tautology Or Oxymoron?

Don't you just love those high-falutin' words?  They're the last ones I'll use today.

Two days ago I wrote about the President's health care advisor, Dr. Ezekiel Emanuel, and his concept of how "allocation of scarce resources" (rationing?) could be accomplished.

I can never tell how interested readers are.  I taught this subject at the University of Maryland, so I feel pretty confident about it.

Other than "Zeke's" complete lives concept, there are a number of principled approaches to deciding "who gets the medical care" when there are resource limitations--whether they be stocks of a drug, number of specialists qualified to care for a particular malady, or the pot of money available.

The issue of distributing medical assets is a wider one than just how to respond in a crisis, or how to deal with an ever-expanding demand for health care.  In any system of supply and demand there are imbalances:  more is available in one geographic location than the demand could support, but in another location supply may be short.  These are questions that economists deal with daily, and I'm not an economist.  I'll focus on the ethical issues only.

My hope is that the next time you watch a disaster unfold, like the earthquake in Haiti, or the next time a public health threat arises, like the H1N1 virus and its vaccine, you will say, "I see, they are maximizing benefit, or helping the highest value people, or--worst case--they have no plan and are screwing it up."

Here's a quick list.  There are four main strategies:  (1) pick the worst off, (2) everybody gets an equal shot, (3) the greatest benefit to the greatest number, and (4) favoring people with the most value.

[If you think valuing some over others is un-American, consider the fact that doctors and nurses got the H1N1 first--each strategy has its place.]

There are technical names and definitions for each of these strategies, but the common sense description works best.  From here, you can break down each strategy into some subcategories.  For instance, under the "equal" treatment category do you give the resources to those who show up, or conduct a lottery?

Each strategy has moral implications for (1) what value we put on a human life, and (2) what we owe to one another.

That's enough for now.  Homework assignment?  (No way).   As you watch TV, not a day goes by that some situation doesn't arise where people need to make these allocation decisions.  See if you can identify the situation and what approach is being taken.  Given the huge flap over rationing and Death Panels in the health care reform debate, stuff like this will be "in your face" for some time.

More on this in later posts.


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