00:01
Now that we've discussed some of the philosophical
background for the concept of resource allocation,
let's go ahead and turn this into how we look at practical
applications for this practice of resource allocation.
00:12
So, one of the things that is helpful to look at
is the AMA opinion that has been rendered
on the allocation of limited medical resources.
The opinion reads as such.
00:24
A physician has a duty or even any clinician has a duty that he
or she can for the benefit of the individual patient.
00:30
Policies for allocating limited resources have the potential to limit
the ability of physicians to fulfill this obligation to patients?
This essentially really drills down to the concept
of the respect for the individual patient
and that this is not lost
in a greater societal concern.
00:48
Physicians have a responsibility therefore
to participate and to contribute their professional expertise
in order to safeguard the interest
of patients in decisions made
at the societal level regarding allocation
or the rationing of health resources.
01:04
One must not lose this concern
for the individual patient.
01:09
With regard to the AMA opinion on
the provision of adequate healthcare,
it reads as such in determining whether
a particular procedure or treatment needs to be included
in the adequate level of healthcare the American
Medical Association code of medical ethics opinions
on allocating medical resources recommends
consideration of the following five ethical principles.
01:29
The first of these is the degree of benefit
and this is obviously the difference
in outcome between treatment
and no treatment.
01:37
The second is the likelihood of benefit.
The third is the duration of benefit.
01:44
The fourth is the cost of the treatment.
And then, finally, is the number of people who will benefit.
01:49
And this refers to the fact that a treatment may benefit the patient
and others who come in contact with the patient.
01:56
This may be seen in a case of a vaccination or an
anti-microbial drug which limits the spread of a disease.
02:03
Let's look at these in each in a little bit more detail.
So, first, was the degree of benefit.
02:07
These criteria prioritize patients who are assessed to have
a greater likelihood of benefiting from a treatment.
02:14
Now, this is important that we look
also at the quality of life
in addition to the mere years added
when we consider degree of benefit.
02:25
The second and third concepts were both
the likelihood and the duration of benefit.
02:29
Let's take a look at these.
02:30
These criteria apply particularly when there is a scarcity
of resource and when that resource scarcity changes.
02:38
So, for example, we may have in the case
of a pandemic, very few ventilators
but then, ventilators become more abundant
as vaccination, for example, becomes available.
02:47
When resources are particularly scarce, priority
needs to be given to the sickest patients
until the scarcity of
the situation improves.
02:56
However, when consideration
is given to the sickest patients,
one must balance the sickness of the patient
with the concept of utility.
03:05
So, not every very sick patient necessarily
gets a resource just because they're sick
because we assess the other side of the coin
as well as the futility that may be involved.
03:16
So, what is medical futility?
Well, futility of care when allocating
resources is a judgment decision
and this is in fact, a judgement that further medical treatment
of a patient would not have useful or successful results.
03:28
One can assume there's a degree of subjectivity
here and this is where ethics committees
or groups of people making decisions
together can be important
so that one particular bias does
not overrule that of others.
03:41
Let's move on to the
fourth of these concepts
and that is the amount and the expense
of resources required that is the costs.
03:47
Now, this cost of benefit is a key issue
and this is the cost that is achieved
by the healthcare intervention especially
when resources are limited.
03:57
This approach tends to favor resources
which are allocated to less expensive treatments
or services providing
the greatest benefit.
04:05
So, either those which don't cause much money
or those which have some cost associated with them
but which exhibit a great
degree of benefit.
04:13
Thirdly, this may be a treatment that produces
a large benefit for a small number of people
or alternatively, a small benefit for
a large number of patients.
04:25
We can look at this in one
way here in particular.
04:27
So, when resources are scarce, they may be
allocated to those who will require less of the resource.
04:33
This maximizes the number of patients
who could benefit from this resource.
04:39
Finally, let's look at the number
of people who benefit.
04:41
The purpose of this resource allocation system
is to optimize the use of limited resources
to provide maximum
benefit on a societal level.
04:50
But remember, this is kept in balance
with our obligation to treat the individual patient.