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Access to Healthcare Lecture.docx

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Western University
Health Sciences
Health Sciences 2610F/G
Ken Kirkwood

HS 2610 Resource Allocation in Health Care March 27, 2014 Access to Healthcare • Issue of Justice Criminal Justice is not the same as Distributive Justice It is about deciding who gets our scarce resources Justice • Distributive Justice  Scarcity is a reality  We can never have enough for everyone Decisions Based on a Concept of “Justice” • Aristotle (384-322 BC) • Principle of distributive justice • “Equals should be treated equally and those who are unequal should be treated unequally” Discrimination • When misused, it leads to wrongful behavior • What it actually means:  Evaluating and choosing between candidates  Equal consideration  Free from intentional bias  Recognizing encultured biased It is based on merit – it only becomes a negative thing when we use considerations that are irrelevant and are based on prejudice Not everyone is your friend – you draw yourself to certain people because of personality traits, and that is a kind of discrimination Candidate’s example – choosing people for programs at university; using marks to determine; based on a relevant criteria Decisions Based on a Concept of Justice • What makes people unequal in healthcare? • Morally relevant differences:  Medical Need (“Acuity”/”Triage”)  Likely Benefit (% chance of recovery) If everyone were to go to the doctor at the same time, everyone would be sorted out because they couldn’t be seen at the same time – the nurse is going to sort out acuity but seeing who is in the biggest jeopardy; they do an assessment and say that one person is sicker than someone else and that creates a line Acuity – the quality of sorting and ranking Triage – how you determine this ranking • Some elements of Justice 1. Does a decision negatively affect some more than others? 1b. are those people the lease able to cope with the results of that decisions? 2. Are the risks taken mostly by one group and benefits enjoyed by another group? When we make decisions, generally, if you make a policy and you’re in charge of a group of people and you make a decision – is this decision going to negatively affect one group of people more than others? If yes, not everyone can benefit from every decision; are you disadvantaging people who are always disadvantaged already? Cases 1. Obligatory organ donation in Ontario 2. Preferential/conditional access to certain surgeries/treatments • Questions of justice:  Q: What is the morally relevant distinction between patients with different BMIs?  A: likely benefit (% chance of recovery)  Q: Is this adversely affecting one group more than others?  A: obesity-poverty link? 3. Tamiflu You won’t give the organ, but you will take it – there are place where if you want to be on an or
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