Case part 3: Consent for blood products
Mr. and Mrs. Callier are relieved to learn that there are suitable options to the blood transfusion and gratefully consent to the surgery using the blood replacement xxx. Unfortunately when you put in an order for the product you are informed that there is insufficient xxx available. In searching a little bit deeper it is discovered that any xxx in the hospital has been set aside by a senior colleague for treatment of a patient who has been on a kidney transplant waiting list for over a year and has specifically asked for xxx instead of blood.
Suggested questions for discussion:
1. How should ethical decisions about resource management be made?
2. How can ethical decisions be made in resource allocation?
In cases where choices have to be made that will inevitably be difficult or dissatisfactory to some, it is helpful to focus on process rather than outcome. If the process by which the decision was made is just, then arguably the outcome is more likely to be just.
This is one proposed process ACCOUNTABILITY FOR REASONABLENESS from Daniels N. Sabin JE. Setting Limits Fairly:
Can we learn to share medical resources? Oxford: Oxford University Press, 2002.
Publicity: decisions and rationales for limits must be publicly accessible
Relevance: rationales should provide “reasonable” explanations (i.e., fair-minded people appealing to mutually justifiable terms)
Revision & Appeals: mechanisms exist for dispute resolution and policy improvement
Regulation (Enforcement): voluntary or public regulation to ensure that conditions above are met
assemble a committee of fair-minded people include a broad spectrum from the organization, include patients, members of the public focus on the REASONABLENESS of the rationales for each decision
put into place processes that ensure TRANSPARENCY and ensure rationales are widely available
design methods to hear appeals of rationales to decisions and to RESPOND to additional evidence
develop mechanisms for institutional ACCOUNTABILITY to ensure the first three steps are followed (Gibson et al)