Rationing
Situation
T.H., a 43-yr-old female patient with cirrhosis of the liver, is
frequently admitted to the hospital. She has been told that her
continued alcohol use will inevitably lead to her death. She now has
GI bleeding and needs blood transfusions. She has a rare blood type
that is hard to match. Should you ask for an ethics consultation?
Ethical/Legal Points for Consideration
• Rationing, or the controlled distribution of scarce resources, is a
difficult ethical problem. The needs of an individual patient or
group of patients are weighed against the needs of many
patients, who may have a greater chance of recovery, and the
availability of the necessary resources.
• Health interests can supersede the interests or rights of a person.
For example, in anticipation of an anthrax attack, the government
could confiscate all relevant antibiotics and restrict their use to
treat the disease.
• Two individual rights that must be considered regarding
rationing are the (1) constitutional right to privacy and (2) right to
consent to or refuse medical procedures and therapy.
• The competent adult is the only person who may consent to or
refuse treatment for his or her health care problems.
• If T.H. consents to a blood transfusion, an intervening party may
be allowed to refuse that treatment only given substantial
intervening circumstances and not as a threat to compel adherent
future behavior.
• If involved parties cannot reach an agreement, legal intervention
by way of a court order may become necessary.
Discussion Questions
1. Do you think patients with diseases that have a behavioral
component, like substance use, deserve aggressive treatment?
2. Would you request an ethics committee consultation in T.H.’s
case?
