Should HECs consider financial costs of care during case review? Yes: HECs should give consideration to cost of care
- Book ID
- 104627503
- Publisher
- Springer
- Year
- 1992
- Tongue
- English
- Weight
- 119 KB
- Volume
- 4
- Category
- Article
- ISSN
- 0956-2737
No coin nor oath required. For personal study only.
✦ Synopsis
The question is not should HECs consider financial costs of care, but how should they do it? 'Should' is a given, in my opinion, because health care is part of an economic, not an altruistic world. (Even though one still hears an occasional, "When it's a matter of life or death, cost should not be a factor.") The reality is that supply and demand, abundance and scarcity are a part of health care and should be addressed by ethics committees as well as by economists.
For HECs, 'How?'means that cost consideration should be subject to ethical analysis. This should be addressed in the committee's educational and policy review/development activities and also in case review. What principle should a HEC apply when addressing cost issues? Of the three ethical principles traditionally employed in biomedical ethics--autonomy, beneficence/non-maleficence, and justice--the latter usually is evoked when cost issues arise. Resource allocation, predicated on scarcity, is cited as the reason for applying distributive justice, fairness, to health care cost decisions. This gives rise to questions of what procedures, which recipients, what source of payment is appropriate? This in turn results in hierarchies or rankings, that are based on determinations of utility.
In a particularly challenging Minnesota case, that of Hilda Wanglie, a different concept was applied by Dr. Steven Miles, a consulting medical ethicist. Mrs. Wanglie was 87-years-old, comatose with severe anoxic encephalopathy, unable to breathe unassisted. She had been in an acute care hospital for the past year, receiving aggressive medical treatment --including respirator, feeding tube, antibiotics for recurrent pneumonia, blood chemistry monitoring and stabilization. Her treating physicians and nurses agreed that continued treatment was not medically appropriate. Her family, husband, and children were all in agreement, and would not consent to withdrawing life-support treatment, although they