RESOURCE ALLOCATION

EQUITABLE DISTRIBUTIONAND JUSTICE

STANDARDS FOR ALLOCATION• ARBITRARY

– AGE– PERSONAL WEALTH– RESOURCE LOTTERY– SOCIAL LOTTERY

• NATURAL– FINITUDE– BENEFIT TO PATIENT– PATIENT SELF-RESTRAINT IN DECISION MAKING

LIMITATIONS ON RESOURCES• FUTILE TREATMENT• COSTWORTHY TREATMENT

– SUFFICIENT BENEFITS FOR BURDENS• SOURCE OF TREATMENT• OTHER SOCIETAL PRIORITIES• WEIGHING ALTERNATIVES

PUBLIC POLICY DECISIONS• DECISIONS ABOUT CATEGORIES OF

PATIENTS• DRIVEN BY SOCIAL UTILITIES• CAUTION ABOUT SPECIAL

INTEREST GROUPS

PATIENT SELF-RESTRAINT• PATIENT VALUES• EXERCISE OF AUTONOMY• REFUSAL OF TREATMENT

– CHOICES AMONG ALTERNATIVES• IMPORTANCE OF INFORMED

CONSENT

DETERMINATION OFBENEFITS FOR PATIENTS• CLEARLY BENEFICIAL• NO BENEFIT (FUTILE)• BURDENS OUTWEIGH BENEFITS

(INADVISABLE)• COSTWORTHINESS• IMPORTANCE OF REALISTIC

ASSESSMENT OF BENEFITS

OREGON’S CRITERIA FOR ALLOCATION• INCREASE LONGEVITY SIGNIFICANTLY• IMPROVE QUALITY OF LIFE

– RESTORE CONSCIOUSNESS– ALLEVIATE PAIN– ALLOW FOR INDEPENDENCE OF FUNCTION– IMPROVE “CARABILITY”

• EFFICIENCY (UTILITARIAN CONSIDERATIONS)• EQUITY

– TREAT SIMILAR CASES SIMILARLY– UNIVERSAL ACCESS TO A BASIC SET OF CARE