Ethical principles of justice in microallocation healthcare resources.

Abstract

Introduction: The scarcity of resources which characterizes the Portuguese health system highlights the need for rationing. If rationing seems difficult at the macro level, it becomes hurtful and dramatic at the micro level, when it becomes necessary to prioritize patients. The ethical dilemmas triggered by this reality are related to the definition of the criteria to determine those priorities. Objectives: This quali-quantitative study explores and compares the views of health professionals and students in Portugal about the appropriate ethical principles for setting priorities between patients. Materials and Methods: A self-administered questionnaire was used to collect data from a random sample of 180 college students and 60 health professionals. Respondents faced a hypothetical bedside rationing dilemma where they had to order four patients (differentiated by personal characteristics and health conditions) and justify their choices. Ordered logit regressions were used to test for differences in ordering and content analysis to categorize the justification of patient’s choices. Results and Discussion: Both groups appeared to support three main rationing principles: (i) health maximisation, (ii) priority to the severely ill and (iii) inter-generational equity. However, health professionals seemed to give greater weight to health maximization and less weight to equality in life expectancy. Conclusion: Although the two groups support a pluralistic viewpoint about how to establish priorities between patients, they do not seem to give the same weight to each ethical principle, a fact that may highlight tensions between how the public and health professionals want to prioritize the micro allocation of scarce resources.