In the UK, Clinical Ethics Committees (CECs) have until recently focussed very much on individual patient care and many have not specifically considered issues of resources. However, as they become more established in acute trusts and develop in primary care trusts (PCTs) they will be more likely to consider issues that have resource implications, as some already have done.
The distribution of limited healthcare resources, be they money, time, equipment, staff, or organs for transplantation, requires setting of priorities. This is so throughout the health service, both at the level of individual patient care (should a patient be prescribed a particular drug?), and at the level of populations (should a PCT spend more on renal dialysis services than prevention of heart disease?).
Questions of allocation of resources involve a range of ethical considerations including fairness, respect for individual autonomy, responding to individual need and benefiting the whole population.
Difficult choices have to be made where pressing claims are made upon a limited budget. For example, should preference be given to:
- Those who are young and have a longer expected time of survival / good health with treatment?
- Those who are parents with dependent children?
- Treating a greater number of patients rather than fewer patients with a greater need?
- Treatment that prolongs life or treatment that improves the quality of life?
- Established treatments rather than experimental treatments?
- Issues of resource allocation and priority setting are likely to present to clinical ethics committees in both acute trusts and PCTs. As a generalisation, committees in acute trusts are more likely to consider issues involving individual patient treatment, whereas CECs in PCTs will consider issues around strategic priority setting. There will be much in common between the two settings, both in terms of issues, and of the principles and values underlying the decisions.
On these pages we explain some of the ethical theories that underpin thinking on resource allocation and consider their application to practical problems. We also look at some topical legal issues. We have listed relevant professional guidance and have suggested some reading material so you can examine these issues in more depth.
This section does not provide a comprehensive overview of the issues around resource allocation, and does not make recommendations about what an ethics committee should do. It highlights issues that a committee may wish to consider and provides some ethical and legal frameworks for approaching the subject.