Choosing a treatment path involves trade-offs

Ethics Forum. Sept. 5, 2005.

How do you handle it when patients can't get every treatment?

Every patient does not have access to all medically indicated treatments, sometimes for economic reasons, sometimes because the needed intervention is scarce or not available. Is there an ethical approach to making decisions about individual patient care when all patients cannot receive all needed treatment?

Reply:

In making decisions at the bedside, we recognize that the core mission of medicine is to heal or at least to alleviate the patient's disease burden and that the patient's autonomy in choosing among the courses of action available for the management of his or her condition must be protected and supported.

In the formulation of policy, it is necessary to take into account a third ethical consideration -- the trade-offs/opportunity costs that the policies entail.

The trade-offs are brought starkly into focus in organ transplantation, for example, by the fact that an organ received by one patient is denied to another who is also on the wait list. Therefore, our objective is to minimize the harm that the policies may inflict on the total population that is affected by them.

The interactions among health care professional, payer, patient and society that have evolved over the past few decades have created tensions that often are cast as ethical conflicts but are, at their root, different assessments of relative costs and advantages to the participants in the medical enterprise.