Principles for allocation of scarce medical interventions (playing God)

Lancet (UK Medical Journal) ^ | 1/31/2009 | Zeke Emanuel, Govind Persad, Alan Wertheimer

[dervish]

Treating people equally

1. Lottery

Hard to corrupt; little information about recipients needed, Ignores other relevant principles

Military draft; schools; vaccination

Include

2. First-come, first-served

Protects existing doctor-patient relationships; little information about recipients needed, Favours wealthy, powerful, and well-connected; ignores other relevant principles

ICU beds; part of organ allocation

Exclude

Favouring the worst-off : prioritarianism

3. Sickest first

Aids those who are suffering right now; appeals to “rule of rescue”; makes sense in temporary scarcity; proxy for being worst off overall, Surreptitious use of prognosis; ignores needs of those who will become sick in future; might falsely assume temporary scarcity; leads to people receiving interventions only after prognosis deteriorates; ignores other relevant principles

Emergency rooms; part of organ allocation

Exclude

4. Youngest first

Benefits those who have had least life; prudent planners have an interest in living to old age

Undesirable priority to infants over adolescents and young adults; ignores other relevant principles, New NVAC/ACIP pandemic flu vaccine proposal

Include

Maximising total benefits: utilitarianism

5. Number of lives saved

Saves more lives, benefiting the greatest number; avoids need for comparative judgments about quality or other aspects of lives Ignores other relevant principles

Past ACIP/NVAC pandemic flu vaccine policy; bioterrorism response policy; disaster triage

Include

6. Prognosis or life-years saved

Maximises life-years produced Ignores other relevant principles, particularly distributive Principles

Penicillin allocation; traditional military triage (prognosis) and disaster triage (life-years saved)

Include

Promoting and rewarding social usefulness

7. Instrumental value

Helps promote other important values; future oriented, Vulnerable to abuse through choice of prioritized occupations or activities; can direct health resources away from health needs

Past and current NVAC/ACIP, pandemic fl u vaccine policy

Include -- but only in some public health emergencies

8. Reciprocity

Rewards those who implemented important values; past oriented, Vulnerable to abuse; can direct health resources away from health needs; intrusive assessment process

Some organ donation policies

Include -- only irreplaceable people who have suffered serious losses

By contrast, the complete lives system combines four morally relevant principles: youngest-fi rst, prognosis, lottery, and saving the most lives. In pandemic situations, it also allocates scarce interventions to people instrumental in realising these four principles. 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.

[dervish]

The most important thing to understand here is that this is being recommended for our REGULAR health care even though the examples and models he uses were all for, pandemics, crises, emergency shortages or scarce organs for transplants.

The shortages here will be self-imposed by the government in order to create “social justice.”

The use of criteria such as youth and utilitarianism are reminiscent of "Life unworthy of life"

http://en.wikipedia.org/wiki/Life_unworthy_of_life

[Da Coyote]

Didn’t see the option that creates a system that has enough physicians to meet the demand.

Oh, forgot, that’s capitalism. Ptui-ptui.

[MontaniSemperLiberi]

“Rational” allocation can sound compelling or fascist, depending on one’s perspective. However, knowing our politicians the way we do, I think we should expect medical care to be given out like highway funds or tax breaks.

[alexander_busek]

Some organ donation policies

Does anyone know if Obama carries a signed organ-donor card with him?

Regards,

[freespirited]

"The shortages here will be self-imposed by the government in order to create 'social justice.'"

Based on the sections of the proposed health care deform legislation that I have read to date, I am forced to conclude that "social justice" means preference to underrepresented minorities.

This entire concept of "social justice" is foreign to me. We have a Constitution. That is my idea of justice.

[Seruzawa]

Proper sequence:

1 - People who work in the private sector except lawyers.
2 - Private sector retirees.
3 - People who work in the public sector like cops or librarians. Appointees and elected officials not included in this category.
4 - Public sector retirees.
5 - People who have been on public assistance (excluding the above retirees) for more than two years.
6- Politicans (if not lawyers).
7- Lawyers.

My categories are based on a persons true worth to society. It is only measured by gainful contribution. People who do not contribute to society go to the back of the line. Professions that cause the greater harm go to the bottom.

If you don’t like it then don’t be a govt employee. Your choice. For the job security you give up preferences. Sorry.... not!

[PapaBear3625]

I’ve read this article before. In a nutshell, it advocates allowing infants and old people to die, so that people who are productive to the State’s interests get preference.

[justiceseeker93]

Hard to believe that the once prestigious Brit medical journal Lancet would stoop so low to have an article like Zeke's published in it. The moral of the story is that once socialized medicine comes in - as it has in Britain - traditional Western medical ethics are inevitably corrupted.

[justiceseeker93]

In 2006, there was a book published (by Regnery) titled "The Party of Death," referring to the Democrats. It was written by Ramesh Ponnuru of the National Review. The 'Rats were out of power then, so only now do we fully realize how poignant that title really was.

[MarMema]

Promoting and rewarding social usefulness

I knew the useless eater tagline was coming....

[dervish]

Ramesh Ponnuru is very pro-life.

And the Obama/Emanuel crew is very pro-death. It is spelled out here - let the infants and seniors die. With the way they devalue infants it is easy to see where their unlimited support for late term abortions comes from.

[SunkenCiv]

Thanks justiceseeker93.

[Alamo-Girl]

Thanks for the ping!

[Munz]

If anyone wants the full PDF PM me with a direct e-mail address and I will send it to you.

[ExTexasRedhead]

HITLER reborn and the Gestapo applauding.

[dervish]

Thanks. I did not realize that I had not posted the PDF link. PDF here

then click the Google link

[Munz]

not a problem, still if anyone wants I can send the pdf. it’s an open invitation :-)