Exploration of Healthcare Rationing

Definition and Criteria for Rationing 

Rationing relates to allocation of the scarce resource of healthcare services by holding back certain beneficial treatments from some people. Ideally, it is very difficult to avoid rationing because very needful circumstances are limitless (Scheunemann & White, 2011). The dilemma in this is how best a person’s life and the societal values can be balanced. Therefore, rationing on the social good, for example, the healthcare services to individuals is inevitable. When approached from an economic perspective, it is almost certain that all resources are scarce, and so healthcare is no exception. As an economic issue, the challenge is evident in the allocation of the limited resource in the most beneficial way. Accordingly, rationing of the healthcare services makes it quite uneasy for a person to acquire beneficial healthcare services. Research contends that during the past, experts utilized old drugs to prevent hemorrhages in patients when doing their surgery. Nonetheless, currently an ethical dilemma has arisen due to drug rationing in health care. In fact, a national shortage of required drugs and other medical equipment emanates from drug makers abandoning low-profit products, federal safety crackdowns, and manufacturing challenges (Fink, 2016). More importantly, the article points out that even though the dearth of the drugs and therapeutics is real, the rationing has been hidden from the public and patients. In this regard, the way that drugs are distributed has occasioned ethical dilemmas. 

Ethical Theory 

Utilitarianism and Rationing 

Utilitarianism is based on the notion that ethical actions are those that produce the greatest benefit for the greatest number of people. It is suggested that a physician can reasonably apply the notion in a certain scenario, only after he/she has found that there are no alternative paternalistic paths, which will have similar results and that he/she occupies the same stance in regards to any relevant non-medical decisions ( Garbutt & Davies, 2014) . Therefore, medical rationing can be justified when the considerations of utilitarianism are applied and when they do not infringe on personal rights. 

Kantianism and Rationing 

The views of Kantianism are typically absolutistic in their rejection of rationing. They assert that one must always respect the rational thinking of other individuals. To deny a person the right to make their own choices, irrespective of whether they are wrong, is to treat them as a means to their wellbeing, instead of the end. Indeed, anti-rationing is already fused into Kantianism since the paradigm forbids lies and coercion, which are the main features of paternalistic thinking ( Garbutt & Davies, 2014) . Since these features are already rejected even to restrict people from harming others, they will be definitely rejected to restrict people from committing self-harm. Certainly, one may accept the latter absolutism in favor of the former. 

Impact on Healthcare and Applicable Measures 

Impact 

Undeniably, maintenance of ethical values in the health care provision is fundamental. In line with the article, without a doubt withholding possibly beneficial treatment for some individuals is a reality and is inevitable because the need for medical supplies is limitless while the resources are scarce. In reality, in order to allocate determinate resources in way that accomplishes a rational equilibrium across the range of fundamental social goods, including health care, hard choices are inevitable. Most importantly, by attempting to accomplish the entire healthcare needs, the capacity to supply the fundamental elements of other social goods such as safety, education or defense would be overwhelmed. 

The necessity of rationing in health care does not mean that regulating is ethically justifiable. However, in business, allocation of scarce resources is one of the concepts that have been discussed in a broad way and needs hard choices. Drug rationing in this case explains how there has been shortages of drugs as well as doctors to provide some services to the patients that results to ethical dilemma (Fink, 2016). With no doubts, health care ethical dilemma such as shortages of drugs and doctors in the healthcare have resulted in the increase in deaths, disease progression, side effects, and medication errors among others. Shortages of drugs have caused some negative impacts such as delayed treatment plus giving patients substitute medics. Most of the physicians do acknowledge that no tracking of these actions’ outcomes is done by healthcare. 

Applicable Measure 

It is a common fact that the healthcare system in the U.S is performing terribly. Despite measures to improve it, like the Affordable Health Care Act, the system is still failing millions of Americans. The healthcare system in the U.S continues to be a problem due to weak structures that have led to high healthcare costs. This problem can be solved with the implementation of Lower Health Care Costs Act. 

The financing of healthcare in the U.S is in a dismal state. It is fragmented with a minimum of four central public systems; out of this, the only comprehensive system is Medicare for retirees (Brodwin, 2017). On the other hand, there is a wide range of private insurance schemes, which exploit patients. In contrast, European nations like Britain and the Netherlands have either direct state funding or universal private insurance, which are administrated effectively (Khazan, 2018). American indemnity firms are profit-oriented and lack efficient customer service. This has led to ever-increasing healthcare costs that many people cannot afford. The American healthcare system is broken, and the measures put in place to fix it are not adequate. The figures from the CDC show that an American citizen is likely to die from diseases than terrorism. This finding brings to light the issue of whether the U.S government has got its priorities wrong since the sum used to find the War on Terror is much higher than that dedicated to the country’s healthcare system. To that end, the U.S healthcare system has slid into a state of crisis due to inadequate funding and lack of focus by the federal government. 

The U.S. government needs to implement aggressive measures so that more citizens in the country have access to high quality and affordable medical care. After U.S. passed the Patient Protection and Affordable Care Act of 2010, most citizens were under the assumption that healthcare in U.S. would greatly improve. However, this was not the case since the issues of cost, access and quality of treatment were not properly addressed by the government. In the healthcare sector, there often exists stakeholders who have the capability of dictating the allocation of medical care in the country. Therefore, these factions undermine the Affordable Care Act (ACA) whose objective is to initiate major overhauls in healthcare through medical insurance and taxation. Based on that reason, disadvantaged individuals who lack sufficient financial resources to attain optimal healthcare would be catered for. 

The Lower Health Care Costs Act was implemented with the aim of subsidizing healthcare costs in the country. Despite the effectiveness of Act’s provisions, there is still a lot of room for improvement. The high cost of healthcare is one of the most serious problems facing the medical sector in U.S. To that end, the bill should be amended to include a provision that states that American government should re-channel some of the funds used to fight terrorism to enhance the country’s healthcare system since the ultimate goal is to ensure the wellbeing of citizens. 

Major Code of Ethics 

The factors surrounding the ethical dilemma is all about how self-sufficiency, beneficence, and distributive justice. Practically, it is quite challenging to live by the principle of autonomy (self-sufficiency) considering that as an individual, your right to pursue your interest may be limited if in any case, that right infringes the rights of others. Beneficence is another ethical dilemma in healthcare in that the health care practitioners are expected to act in the best interest of the patients while they discharge their official duties. Alternatively, distributive justice entails fairness in a manner that every individual has a fair right to access healthcare or medical services irrespective of one’s race, age, sex, income or religious affiliation. However, instead of applying the resources to achieve the greatest common good in the healthcare, the rule of rescue often takes the center stage and the services are channeled to the neediest cases. 

Impact of the Issue on Final Decision on Stakeholders 

Just like any other social good, health care is a scarce resource and limited resources are often rationed in one way or another. In this regard, rationing health care encompasses the acquisition of value for the billions of dollars that individuals spend via setting of restrictions on which treatments should be purchased from the public purse. More often, physicians fail to invite hospitals and immediate healthcare experts who deal with patients regarding the rationing concern. Although there is a shortage of drugs in the recent, some decisions on where to allocate drugs should be left to those who understand the needs of affected parties. The discussion above has mentioned some to the critical ethical issues in the provision of healthcare services. Such issues are challenging to avoid when a consideration is drawn on matters of greatest common good and the neediest situation of an individual. However, rationing in healthcare will continue to be an issue bearing in mind the ethical need for fairer allocation of medical care services. 

Nurses should play a key role in changing this current state by supporting the Lower Health Care Costs Act. Nurses play a vital role in the health continuum; therefore, it is about time they take a firm stand by advocating for the Act since it will transform America’s healthcare landscape. Nurse leaders should take the forefront and call for reforms. Organizations like the National Nurses United (NNU) and the American Nurses Association (ANA) have the power to usher in change since their large numbers will force legislators to take notice if they protest. America's healthcare system should be restructured to cater for everybody irrespective of one's income or social status. 

Policy Implications 

Under the conditions of scarcity, question often arise regarding the rationing of medical supplies. In this regard, resource allocation should be pegged on need as it eliminates prejudice centered on the presumptions that the poor or the elderly benefit less from the health care interventions. Besides, the issue of scares resources allocation is a great challenge and also affects healthcare such as drug rationing and have resulted in ethical dilemma (Fink, 2016). In reality, lack of drugs and shortage of doctors demonstrates a national challenge that requires quick and positive focus for a better future. 

References 

Fink, S. (2016, Jan. 29). Drug rationing: an ethical dilemma. The Bulletin . Retrieved from, http://www.bendbulletin.com/business/3950489-151/drug-rationing-an-ethical-dilemma# 

Brodwin, E. (2017). “A coalition of the most advanced countries summed up what's wrong with America's healthcare system in 2 points.” Business Insider . Retrieved from https://www.businessinsider.com/why-us-health-care-bad-oecd-2017-6?IR=T 

Khazan, O. (2018). “The 3 Reasons the U.S. Health-Care System Is the Worst.” The Atlantic Retrieved from https://www.theatlantic.com/health/archive/2018/06/the-3-reasons-the-us-healthcare-system-is-the-worst/563519/ 

Mandal, J., Ponnambath, D. K., & Parija, S. C. (2016). Utilitarian and deontological ethics in medicine.  Tropical parasitology ,  6 (1), 5. 

Scheunemann, P.L. & White, B.D. (2011). The ethics and reality of rationing in medicine. American College of Chest Physicians. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415127/