Introduction
When the necessity of healthcare rationing arises, those in society who are more vulnerable, such as the elderly, minorities, immigrants, and individuals with disabilities, are typically put in danger. Prioritizing patients with the greatest prognosis is advocated for healthcare practitioners. Due to the increased pressures on limited resources distribution, COVID-19 caused much controversy about the possible consequences of healthcare rationing. COVID-19 exposed hospitals to difficulties in emergency decision-making and made it evident that funding is necessary to be spent on hospital resources, such as equipment, medication, and the employment of more staff. For that matter, this paper is designed to claim that healthcare rationing is problematic because it leads to various types of discrimination against marginalized and disadvantaged populations due to the use of color-blind criteria.
Healthcare Rationing and Its Occurrence
Health service rationing entails limiting some people’s access to essential healthcare services due to resource constraints. Although “treating patients equally should be a central goal of medicine,” it is not always possible due to the limited capacity of the healthcare systems in times of emergencies (Schmidt et al., 2021, p. 126). Healthcare rationing occurs when insufficient supplies and excessive demand for resources such as equipment and a low number of hospital staff make it difficult to provide healthcare to everyone who requires it (Fink, 2020). When the number of patients exceeds the number of available means, hospital staff must “decide which ones would get the lifesaving resources,” leaving some ‘unlucky’ patients without chances for survival (Fink, 2020, p. 1). Thus, when pressured by the dilemmas of whom to save, hospitals refer to triage practices, which obstruct the opportunities of providing equal care to all.
Reasons Why Healthcare Rationing Is Problematic
Discrimination Among the Chronically Ill
The chronically ill are the ones who are most affected by healthcare rationing and are most discriminated against. Indeed, during the COVID-19 pandemic, hospitals relied on “the premise that ventilators would be wasted on someone who might die while being ventilated or might die soon after leaving the hospital” (pp. 126-127). Since people with chronic conditions, such as diabetes, renal failure, and others, require more resources while their chances of survival are slim, they are not prioritized under the criteria of social and economic worth (Fink, 2020). However, such an approach discriminates against this vulnerable population since they are exposed to the exacerbation of their ongoing suffering. On the other hand, the chronically ill often “affirm their wish to go on living and appreciate their positive experiences, but refuse to live under the current conditions (Kremeike et al., 2018, p. 2). Thus, a non-discriminatory practice should provide chronically ill patients with an opportunity to express their willingness to obtain scarce treatment resources given their condition.
Racial Discrimination
Since historical and social preconditions contribute to racial minorities’ vulnerability across multiple aspects of their life, rationing medical care is discriminatory because it aggravates their disadvantageous position. According to Fink (2020), “using predicted survival to determine access to resources… might be inherently discriminatory” for racial minorities due to “institutional racism in the health care system” (p. 4). For example, African Americans’ poor health reflects their historical and systemic limitations, while their white counterparts have higher rates of survival within the framework of rationing due to their better historically predetermined opportunities. As stated by Schmidt et al. (2021), rationing based on life expectancy is discriminatory because inherently advantaged white individuals enjoy higher life expectancy due to such structural factors as “more favorable work, living, and housing situations, better access to public health measures and health insurance” (p. 126). Therefore, the failure to incorporate structural and historical context for the disadvantaged populations in the rationing of medical care will lead to more deaths, which should be avoided at all costs.
Discrimination Against Immigrants and the Poor
Rationing medical care might contribute to society’s polarization due to discrimination against the poor and immigrants. The surviving society will still be at war with itself despite the possibility that the selected criterion may save more lives. Indeed, during rationing, immigrants’ disproportionate experiences of inequalities in society and across institutions due to their status expose them to being “skewed because they had not received the same quality of care” (Fink, 2020, p. 4). Similarly, the poor have economically vulnerable conditions of life, which limit their opportunities for higher life expectancy and survival rate, which dismisses these criteria as justice-based rationing. Indeed, using survival chances and social worth based on underlying health conditions means “punishing people for their station in life,” which is a direct manifestation of discrimination (Fink, 2020, p. 6). Thus, it is essential to incorporate sensible triage criteria to ensure that disadvantaged immigrants and people with low socio-economic status are not discriminated against.
Discrimination Against the Disabled
Individuals with disabilities have historically been victims of discrimination, and commonly used rationing principles perceive their lives as less worthy than those without disabilities. The survival-based “scoring systems are unlikely to predict critical care outcomes with sufficient accuracy” and fail to provide equal opportunities for treatment to people with disabilities (Schmidt et al., 2021, p. 129). Therefore, the current rationing approach “echoes the collective historical trauma in the disability community, in which people with disabilities are viewed as inherently “less than” and disposable” (Lund & Ayers, 2020, p. S210). Families of disabled individuals are also anxious about the value of their dear ones’ lives being diminished in the case of sickness and rationing. These worries significantly increase the already significant pressures created by the epidemic.
How Health Rationing Affects Nursing Profession
Nursing professionals are affected by healthcare rationing because they must make difficult decisions about rationing on more equal terms without discrimination. Moral philosophy and ethics have debated how to tell whether to save someone and when to let them die. Since the number of critically sick patients is increasing exponentially and there are acute shortages, it becomes much more difficult to make accurate decisions. Rationing is necessary, and when compelled, the nurses must choose the course of action that would result in the least harm, preferably “valuing lives more equally and reducing probable implicit bias” (Schmidt et al., 2021, p. 128). In general, “health workers are urging efforts to suppress the outbreak and expand medical capacity so that rationing will be unnecessary (Fink et al., 2020, p. 1). Thus, healthcare professionals and decision-makers must instill non-discriminatory rationing practices to empower the nursing staff to serve their professional purposes ethically.
Conclusion
In summary, due to scarce resources and excessive demand during emergencies, offering healthcare to everyone who needs it is challenging. As a result, rationing and precedence selection must be used. Healthcare rationing is essential, inevitable, and morally challenging. The allocation degrees and the rationing openness are crucial structural factors in developing a fair healthcare system. Fairly implemented principles are essential for principled rationing. It matters how limiting works since it has not only an influence on people’s lives but also links the principles that civilization values most. The resources in the world are constrained, but necessity is not, and healthcare is not exempt from the implications. Governments should establish the regulations and guidelines required for healthcare rationing to relieve practitioners of the burden.
References
Fink, S. (2020). The hardest questions doctors may face: Who will be saved? Who won’t? The New York Times. Web.
Kremeike, K., Galushko, M., Frerich, G., Romotzky, V., Hamacher, S., Rodin, G., Pfaff, H., & Voltz, R. (2018). The DEsire to DIe in palliative care: Optimization of management (DEDIPOM) – a study protocol. BMC Palliative Care, 17(1), 1-10. Web.
Lund, E. M., & Ayers, K. B. (2020). Raising awareness of disabled lives and health care rationing during the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S210–S211. Web.
Schmidt, H., Roberts, D. E., & Eneanya, N. D. (2021). Rationing, racism, and justice: Advancing the debate around “colorblind” COVID-19 ventilator allocation. Journal of Medical Ethics, 48(2), 126-130. Web.