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Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness.
No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years.
We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.
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Re: Principles for Allocation of Scarce Medical Interventions
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considers prognosis, since its aim is to achieve complete lives. A young person with a poor prognosis has had a few life-years but lacks the potential to live a complete life.
Considering prognosis forestalls the concern the disproportionately large amounts of resources will be directed to young people with poor prognoses. When the worst-off can benefit only slightly while better-off people could benefit greatly, allocating to the better-off is often justifiable….
When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.
Re: Principles for Allocation of Scarce Medical Interventions
Looks like Palin nailed where these folks are headed.
Combine this with the Obama vid stating that he want a single payer and getting rid of Private Insurance, and regretting that it might take 10-15 years to get rid of private insurance.
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"Some guys play in all-star games, some guys don't. I don't know who picks all those all-star teams. In all honesty, I don't know who picks the combine, for that matter," Belichick said. "How does (Miami-Ohio offensive lineman Brandon) Brooks not get invited to the combine? How did Vollmer not get invited to the combine? I don't know. We can't really worry about that. We just have to try to evaluate them the best we can."
Re: Principles for Allocation of Scarce Medical Interventions
I don't suppose you troubled to read the entire article. Please provide any description of an ethical framework, including that of the status quo, that could not be assailed with the stamp of approval "Looks like [your name here] was right."
Perhaps you should have read the conclusion as well....
Quote:
Ultimately, none of the eight simple principles recognize all morally relevant values, and some recognise irrelevant values. ....By contrast, the complete lives system combines four morally relevant principles: youngest-first, prognosis, lottery, and saving the most lives. ... Importantly, it is not an algorithm, but a framework that expresses widely affirmed values: priority to the worst-off, maximising benefits, and treating people equally. To achieve a just allocation of scarce medical interventions, society must embrace the challenge of implementing a coherent multiprinciple framework rather than relying on simple principles or retreating to the status quo.
Frankly, if I am 80 and a 20-year old kid and I both need a liver; and I'm a six-drink-a-day guy and he is a tea-totler; and I've been exposed to hepatitis and he has not been; I hardly think we should both compete by lottery for the liver. Even less do I think that if I have more money or access to more money (via a better insurance situation) that I should get the liver. But that's the fact: if I'm not insured and the condition is not transpiring in the ER (i.e., it's a known condition,) I will be SOL under the current system. But fear not - I'm likely never to be diagnosed since I have little access to medical care in the first place.
Clearly, since we are talking about scarce resources (and not, it should be pointed out, the average every-day interventions that most health-care is about,) it seems like a no-brainer that some system other than pure lottery is almost certain to be in play.
Obviously the long-term challenge is to be able to grow our own organs etc., and defeat the scarcity of said resources technologically. But one needs only to scan our life expectancy, prevention of preventable deaths, infant mortality, and other universally recognized stats to determine that our care across society is allocated using irrelevant considerations.
Keep trying to scare the old folks. Even this article -- written in a bloody ethics column in Lancet -- only tips the hat to "youngest-first" as one of several rational principles to be combined in a "framework, not an algorithm."
The notion that a medical ethicist should have no place on Obama's health care team makes no sense. Any medical ethicist's writings will be repugnant when compared to a vacuum of bad things (after all, any health prioritization will result in bad things, but just the negation of all health care is bad-thing neutral, since no care is specified.)
But the principle you point out -- youngest first -- indeed has a good deal of weight in this framework. If you can get 4 months out of an organ and somebody else can get 40 years, the framework proposed in this paper suggest that should be taken into account. Within Emanuel et al.'s framework, you have a weighted lottery, with attenuated chances at the golden ticket in your Wonka bar as you age (and prior to age 15.) As it stands we devote the majority of our care dollars to the first and last years of life. How fair is that to those in the middle of life?
A final note, by the way: Nobody on Obama's health team has written any health care bill. That is being done in congress.
Re: Principles for Allocation of Scarce Medical Interventions
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Originally Posted by PatsFanInVa
A final note, by the way: Nobody on Obama's health team has written any health care bill. That is being done in congress.
PFnV
Writings like this point out the need to have debate .... a long debate about this. What is angering people so much and rightly so is the speed with which the democrats tried to ram this bill through to vote. Congress has taken advantage of the Obama popularity to change the traditional methods of proper debate ... America rejects this. The left is being blamed for the outrage and actually it is the independants who are against this and by @ %75 margin and that's the swing area.
How do you slow down a speeding train? With a loud rejection of the process. Anyone who does not favor debate is missing the boat ... now if only there had been more debate when Bush was in office --- yes --- that's what we need to get back to is debate.
BTW ... the healthcare bill, Afghanistan projections, cap and trade ... America is waking up ... perhaps 9 years to late but waking up is better than dozing. Someone needs to pay and the rich are not as rich as they were a few years ago.
Re: Principles for Allocation of Scarce Medical Interventions
Well now, Icy, in a perfect world I may agree with you on the speed of the process.
In the world we're in, we saw national health care reform die on the vine in the 90s, and we have seen in the various bills making the rounds that Obama chose the most palateable and least radical notions that will get the job done, jettisoning single payer for public option... which in itself is painted by our worthy board-mates and their ideological brothers-in-arms as somehow socialist or Nazi depending on the day.... when in fact SOME form of national health care is simply what civilized nations do (our own excepted.)
I do agree with you that the pace is not optimal. But we're dealing with an opposition that says "hold on wait a minute" until the proverbial patient is nearly dead, then says "oh screw it pull the plug." That was their stance on the auto industry, with a liberal dose of "it'll never happen in X days anyway. HAH!"
Here's Gallup's poll on reform: 41% say do it this year, 30% say do it but not necessarily by the end of this year, 21% say don't do it at all, and 5% say don't know or refused to answer.
Those who say reform it do not necessarily favor the bills they have heard of, if both the above 7/27 poll and this 7/29 poll are representative and valid:
In this one, 34% say health care reform would worsen care in the U.S., and 14% say nothing would change.
As we all know, what you ask matters. The first question seems to be a "should we get it done?" question, and the second one is more in line with expectations of results -- so there seem to be a good number of people who say we should give it a try but are just plain pessimistic. Some people apparently think we should get it done not necessarily this year... but that if it gets done it will worsen care. My guess would be they believe it should be done but that reading the present tea leaves, they believe it will be a failure if done at the present pace.
Last but not least, Obama's approval rating went up 4 points week-over-week in the Aug. 3 poll:
Re: Principles for Allocation of Scarce Medical Interventions
Quote:
Originally Posted by PatsFanInVa
Well now, Icy, in a perfect world I may agree with you on the speed of the process.
In the world we're in, we saw national health care reform die on the vine in the 90s, and we have seen in the various bills making the rounds that Obama chose the most palateable and least radical notions that will get the job done, jettisoning single payer for public option... which in itself is painted by our worthy board-mates and their ideological brothers-in-arms as somehow socialist or Nazi depending on the day.... when in fact SOME form of national health care is simply what civilized nations do (our own excepted.)
I do agree with you that the pace is not optimal. But we're dealing with an opposition that says "hold on wait a minute" until the proverbial patient is nearly dead, then says "oh screw it pull the plug." That was their stance on the auto industry, with a liberal dose of "it'll never happen in X days anyway. HAH!"
Here's Gallup's poll on reform: 41% say do it this year, 30% say do it but not necessarily by the end of this year, 21% say don't do it at all, and 5% say don't know or refused to answer.
Those who say reform it do not necessarily favor the bills they have heard of, if both the above 7/27 poll and this 7/29 poll are representative and valid:
In this one, 34% say health care reform would worsen care in the U.S., and 14% say nothing would change.
As we all know, what you ask matters. The first question seems to be a "should we get it done?" question, and the second one is more in line with expectations of results -- so there seem to be a good number of people who say we should give it a try but are just plain pessimistic. Some people apparently think we should get it done not necessarily this year... but that if it gets done it will worsen care. My guess would be they believe it should be done but that reading the present tea leaves, they believe it will be a failure if done at the present pace.
Last but not least, Obama's approval rating went up 4 points week-over-week in the Aug. 3 poll:
Re: Principles for Allocation of Scarce Medical Interventions
Ezekial J Emanuel is not just an a health care advisor. He's it's chief proponent. The so called "Health Czar" if you will.
He is a "Hoch and Binding" guy from many years ago. Mention that and you're label a fear-monger, but nonetheless, it's the truth.
If you honestly think less "poor" people will suffer and die under a purely socialized system, your are 1) uninformed, and 2) clueless.
Widening the bottle, and narrowing the mouth will force rationing. Rationing will put political considerations into medical decision. what could go wrong?
Principles for Allocation of Scarce Medical Interventions
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