Ethical principles of justice in microallocation healthcare resources.

Abstract

Introduction: In a context of scarcity prioritization patients is plagued with ethical dilemmas focusing on principles of efficiency and equity. To define reasonable criteria for microallocation decisions requires knowing the ethical principles of justice defended by society. Objectives: This study attempts to: 1) identify and compare the opinion of two groups of the Portuguese society - people in general and health professionals, about the personal characteristics of patients they value when prioritizing them; 2) understand the reasons behind that choice in order to fit them under efficiency or equity orientations. Methods: Using quantitative and qualitative methods a sample of 180 college students and 60 health professionals were studied. A questionnaire was developed with eleven hypothetical emergence scenarios. Respondents must decide and justify which patients to treat when only one bed is available. Patients are distinguished by personal characteristics summarized in three types: 1) inherent to the person (age, sex, race); 2) person’s relations with others in society (having children; marital status; economic status; labor status) and 3) person’s causal relation with illness (smoking, drinking). Results: Findings suggest the: 1) existence of significant differences in the choices made by both groups with health professionals to choose more often assign equal priority to patient’s; 2) coexistence of equity and utilitarianism orientations among both groups even though efficiency received the greatest support especially by health professionals. Conclusions: Results suggest the acceptance of social criteria in the microallocation of health resources primarily for utilitarianism reasons.