Here is a fragment of a conversation between two health administrators. They are thinking about how to frame policy regarding access to health resources:
ADMINISTRATOR A: I think we have to draw a line somehow with people presenting to hospitals with diseases related to smoking, heavy consumption of alcohol, and the like. These illnesses are the result of a chosen way of living, and in the face of information available to everybody for a long time about the risks to health involved in living this way. I think we should offer treatment only when these people have clearly quit smoking or drinking; or, at the very least, we should give other people priority in the surgery lists. It isn’t fair that society should have to keep funding ‘repair jobs’ on these people when there are so many other health care needs to be met even now. And, instead of pouring money into these irresponsible people, it makes more sense to invest in health promotion for future generations: prevention of smoking- and alcohol-related illness is much cheaper than cure, and there are potentially many more people who will be benefited by this than will benefit from curative intervention in the present.
ADMINISTRATOR B: Well, if we’re going to talk about responsibility, then we need to note that lots of smokers and heavy drinkers live this way because of pressures and troubles in their lives, a lot of which is beyond their control. And if we’re going to talk about fairness, then my view is that we should have a principle of meeting people’s health needs as far as possible, regardless of why they have the needs they do: that is what a civilized society should aim for. As for the future generations, they are future, not present; and they only have potential problems, not actual ones. We should give first priority to present and actual health needs: never mind about ‘greater numbers’.
DISCUSSION SHOULD FOCUS AROUND THE FOLLOWING QUESTIONS:
Which administrator do you most agree with? Why?
Given the limitation on funding and resources in the health system, what factors do you think should be given priority when decisions are made on how to meet people’s health needs? Should health services be rationed? How could rationing be made to work fairly for all members of the population?
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