The cost of choice: Allocation of scarce resources

In the year 1960, Dr. Belding Scribner developed a device that allowed for patients with kidney disease to undergo hemodialysis without having to go through multiple surgeries. This was a revolutionary development, so it attracted a lot of people with kidney disease to come forward as volunteers for testing of this product. Since this was only the beginning of the creation of the device, the volunteers far outnumbered the amount of devices available for testing. With this dilemma at hand, Dr. Belding with a group at the Swedish hospital in Seattle created a committee of admissions and policy that would set the criteria for receiving treatment. Their criteria included that only residents of Washington state were to receive treatment since their tax money was what funded the research. Children and adults over 45 years of age were excluded since they might not be able to withstand the device yet at its experimental stage and may cause them more harm than good.

Contents

Cases

Natural disasters:
Human disasters:
Organ transplantation:
Spot in research:

Views

Lottery:

Objections

Choosing deliberately:

Emergencies
Conclusion
Bibliography

Once the pool of people had been cut down they still didn’t have enough, so they needed to reduce the amount of people again. They first thought that allowing a randomized pick would be the most fair way to go about this, but later decided against it and instead decided to pick based on social value. The factors they used to determine someone’s social value included age, sex, occupation, income, education, marital status, number of dependents, and past contributions to society. By the end of the 1960s, 87 renal centers around the United States had performed these operations and tests with candidates selected based on their various criteria. Throughout the country the majority of those candidates selected were white, married, middle aged men.(McConnell, T.)

In the times of crisis, whether that be pandemic or natural disasters, there comes a period where resources become limited. In these situations multiple people are in danger and will need assistance, but there simply isn’t enough resources to go around. Unpleasant decisions must be made quickly while taking the ethics of the situation into account.

Cases

Natural disasters:

Volcanic eruptions, earthquakes and tsunamis are all large scale natural disasters that end up affecting many people and infrastructures. In these cases it is hard to determine who should gain access to emergency healthcare and other necessary resources. Especially in the case of a shortage, where there isn’t enough to go around for everyone. Many things need to be considered. Should the allocation of resources go to those most injured with a low chance of survival or ones that aren’t as badly injured but have a better chance of surviving? Sometimes multiple people can have a high chance of survival but while the first batch of people are getting aid the chances of survival of the others goes lower. How are we to decide who goes first?

Human disasters:

Bombings, wars, chemical leaks or explosions, and arson are all examples of disasters created by humans that need immediate action and response. How do we determine who gets aid first in these cases? Do the people closest to the disaster get aid first even though there’s a chance they might not make it, or once again the ones that have a high chance of survival because they were not as close to the area of impact? Disasters such as these happen extremely frequently, fires break out all over the whole due to human negligence and it ends up impacting a large pool of unsuspecting passersby. In the cases of war, many of the victims of those wars are people that are not even participants. Ordinary citizens getting bombed, their houses demolished and their families in critical danger simply because of the unfortunate circumstance of being born in the wrong place at the wrong time. Once the resources of the country start running out and other countries start outsourcing their resources to the victims, how do they decide who gets the resources? A lot of the time the countries who are in alliance with the outsourcing country get the most resources. Is it fair to say that simply because a government is in disagreement with another that the citizens of the country in war should not receive possibly life saving resources, or should receive only a small percentage in comparison to the country with which the outsourcing government is not in disagreement with?

Organ transplantation:

In the US alone, there are over 100,000 people waiting in line for an organ donor. Once an organ is donated it is extremely difficult to determine who gets it first. Just as the previous cases, is it ethical to go based on who will survive the procedure and live on longer or does everyone deserve a chance at a life? At the end of the day, even if one were to get an organ transplant on the basis that they have a higher chance of living a long life, that doesn’t really mean all that much since people die all the time. Death happens everyday , not only through health complications, but in other ways. Small unavoidable accidents that absolutely no one could’ve predicted is an example. Is it ethical to determine who gets the transplant based, not on longevity, but instead on perceived or assumed quality of life? A person may have a good quality of life at the moment, but anything can happen at any time that can quickly deplete that quality. Does it even matter? Should people not get a chance at life just because of their perceived quality of life? Also, who determines which kinds of life are qualitative and which ones aren’t?

Spot in research:

In the cases of many fatal and life threatening illnesses people are mostly eager to be the subjects of experimental drugs and research. Sometimes these experimental medications are not enough to go around everyone that wants to be tested. That of course isn’t ideal, since illnesses can manifest so differently in just a small batch of people. Researchers are not always sure how the medication will work, if at all, on all the multiple variations. What if the experiments work and the chosen few get healed, and by then in the ones that weren’t chosen the pathogen mutates and the drug no longer works for them. Perhaps, by then, they succumb to their illness completely.

Views

Lottery:

There are two main arguments when it comes to who deserves scarce resources in the times of emergency. The lottery and choosing deliberately are the two sides. The lottery is a more randomized approach. The people selected could quite literally be chosen through a lottery or on a first come first serve basis. Many benefits come with this method as no one is unfairly discriminated against and everyone gets a fair chance. This actually helps in dissolving any animosity between the ones that were chosen and the ones that were not.

Objections

There are two main objections that come with using the lottery method in selecting candidates though.

•Saving as many people as possible, people argue that saving as many people as possible is the best approach. To them, the way to do so is that people that can aid in the rescues should be given priority. Healthcare workers in the cases of an outbreak are a great example. If more healthcare workers were saved, they would be able to directly aid in saving more people. If they are infected they will easily spread the disease to so many others. This also applies to all sorts of first responders. Police and fire fighters can all aid in saving as many people as possible if they themselves are saved.

•Exclusions, some people believe, in the case that the lottery method is used and a criminal serving a sentence were to get picked, they should automatically be excluded. In that case how do we determine which types of crimes are to be excluded or should this exclusion be for all sorts of criminals? How do we determine which civil, criminal or juvenile cases get exonerated? Would it be fair to exclude a petty or juvenile criminal of a life saving procedure or treatment? Does the decision change if they are a first time offender? What of the wrongfully convicted, do they also get excluded?

Choosing deliberately:

Choosing deliberately is defended by many people. One of the more famous ones is Nicolas Rescher. Nicolas has a system of stages that he believes will aid us to save as many lives as possible in the best way possible.

•Stage 1(Criteria of inclusion), this stage helps in narrowing the number of people to a workable amount through things such as;

○Constituency factor, he believes that the natural and usual clients of the institute delivering the treatment should be given first priority.

○Prospect of success factor, those who are most likely to survive the procedure should be given priority.

○Progess in science factor, those whose inclusion will advance science and aid the research in finding better cures or solutions.

•Stage 2(Criteria of comparison), the stage that helps in picking out the people to be helped after the majority have been excluded includes;

○Relative likelihood of success factor, this also touches on the likelihood of surviving the procedure or situation.

○Life expectancy factor, the people that have the best chance at living a long life. This can exclude patients that may have another illness alongside the one being discussed. Age is also a determinant in this case and overall lifestyle.

○Number of dependents, this discusses whether this person has multiple people dependent on them, and how many at that. It also means people that have contributed the largest to their community and society as a whole or the likelihood that they might contribute at large to the community if they were to live longer.

Emergencies

In the cases of emergencies people are categorized into three parts. One is those who cannot survive no matter how early they are given treatment. Then there are those who can be saved but only if given treatment early. Finally, those who can be saved even if treatment is heavily delayed. The first category are usually not considered for treatment in cases of emergency, since they will not make it regardless and the resources are scarce enough already. The second category of people are the first priority for receiving treatment. They include pregnant women, children and healthcare workers. Healthcare workers are put into this category because they are constantly around the sick and so can easily contract the illness and spread it, especially to those with compromised or weakened immune systems. The third category are those individuals whose bodies can withstand and hold down the illness long enough without too much of an issue. These people are the last to receive treatment most of the time.

Conclusion

During the COVID-19 pandemic hospitals were filled with patients coming in daily. The resources of the hospitals started becoming scarce and healthcare providers had to make tough calls as to who would receive them based on a number of criteria. The allocation of scarce medical resources is a sensitive topic that needs to be discussed and decided with care. These decisions affect people’s lives and in the times of emergencies we cannot afford to panic or not make a decision at all, as that will end up affecting everyone negatively. It is important to consider the ethical implications for the criteria that may be set in place for those selected. One cannot play into internal biases and prejudices as this is a conversation of human life. Transparency with the public may help in settling the harsh reality of these decisions. Open discussions are important to ensure the best decisions are being made.