Introduction
Healthcare rationing is a major ethical issue due to which some individuals get reliable care while others do not. It is usually experienced when there is a shortage of healthcare resources, such as the impact of a pandemic and disaster (Singh & Moodley, 2020). The outbreak of the COVID-19 pandemic increased the demand for care, hence leading to rationing. For example, Italy focused more on treating the young than the old because the resources were inadequate. Rationing impacts the nursing profession because it enhances collaboration to make informed decisions (Born & Levinson, 2019). Therefore, healthcare rationing can have serious negative impacts on individuals and society, such as a decrease in quality of care and unequal access to treatments.
An Overview of Healthcare Rationing
Healthcare rationing implies a situation where providers select who is going to get care. It is an intervention where healthcare resources are distributed based on some rationale or restrictions provided. Fink (2020) states that “the medical director of the intensive care unit had to choose which patients’ lives would be supported by ventilators and other equipment” (para 1) If the number of patients in the ICU exceeds the resources, the providers must consider rationing to enhance care. Furthermore, Dr. Evans claims, “Hospital officials asked her to decide which ones would get the lifesaving resources” (Fink, 2020, para 2). The provider was tasked with the mandate of developing a system of choosing the patients to use the ventilators. This was a challenging situation for Dr. Evans because there was no existing procedure to follow. Therefore, healthcare rationing is a process where a healthcare provider decides who uses the healthcare resources when there is a shortage.
Healthcare rationing based on age results in the unjust allocation of resources, as the elderly population is often considered a burden on the healthcare system and society. According to Fink, “Health workers are urging efforts to suppress the outbreak and expand medical capacity so that rationing will be unnecessary” (Fink, 2020, para 4). On a moral level, age-based rationing of healthcare can be seen as a form of discrimination, as it can limit the rights of the elderly to access the same care and resources as younger people. Moreover, Fink posits, “overwhelmed doctors are withholding ventilators from older, sicker adults so they can go to younger, healthier patients” (Fink, 2020, para 5). This can lead to feelings of isolation and marginalization among the elderly, who may feel like they are being treated unfairly or neglected. Thus, rationing healthcare based on age can have serious health implications.
The Causes of Healthcare Rationing
There are several situations where healthcare rationing occurs the most. Firstly, during a pandemic, such as COVID-19 and the H1N1 flu. “Medical providers are considering these questions based on what first occurred in China, where many sick patients were initially turned away from hospitals” (Fink, 2020, para 5). During the outbreak of the COVID-19 pandemic, China decided to ration healthcare services because the resources were inadequate. The priority was being to people with the coronavirus. In addition, in the US, “The Veterans Health Administration develop what are essentially rationing plans for a severe pandemic” (Fink, 2020, para 7). Healthcare officials must outline the strategies for undertaking health care ration in preparation for a pandemic such as COVID-19. As a result, the pandemic leads to healthcare rationing because it causes a surge in healthcare demand.
Secondly, the other situation resulting in health care rationing is a natural disaster. According to Bell et al. (2021), the aftermath of hurricanes, earthquakes, tsunamis, and other disasters can have a substantial burden on the impacted population and compromise the healthcare system due to an increase in the number of patients seeking care. After the occurrence of Hurricane Sandy, “Dr. Laura Evans would be left with only six power outlets for the unit’s 50 patients” (Fink, 2020, para 1). She had to decide how all the patients in the ICU were going to share the available outlets. This was a difficult situation because everyone was important and needed care. “Now, she and doctors at hospitals across the country may have to make similarly wrenching decisions about rationing on a far bigger scale” (Fink, 2020, para 3). Dr. Evans and other providers would have to choose six patients out of the 50 to use the ventilators. Therefore, disasters can have an adverse impact on hospital resources, causing a shortage.
The Implication of Healthcare Rationing
Healthcare rationing limits access to care by reducing the number of patients who receive care. The most obvious negative effect of healthcare rationing is that it limits access to necessary treatments and services. Dr. Evans states that “Hospital officials asked her to decide which ones would get the lifesaving resources” (Fink, 2020, para 2). This can be especially problematic in the case of life-saving treatments or therapies, as those who cannot afford them may not receive the care they need. Additionally, the process adversely impacts individuals with low chances of survival.” Unlike in Italy, where age has been used in rationing treatment, some people developing protocols elsewhere have de-emphasized it” (Fink, 2020, para 36). In the Italian intervention, the young were positively influenced, whereas the old suffered because they were not given appropriate care. As a result, healthcare rationing is problematic because it adversely impacts healthcare delivery.
Healthcare rationing is challenging because it is an ethical dilemma, and a provider is torn between choices that are considered morally correct. It devalues human life and limits access to certain types of health care. According to Dr. Metra, choosing between patients “goes against the way we used to think about our profession, against the way we think about our behavior with a patient” (Fink, 2020, para 6). For example, it would be hard for a healthcare provider to remove a ventilator from one and give it to another. In addition, rationing is a problem because it denies people the opportunity to get treatment. As shown in the case, China had to turn many sick patients away from hospitals to give priority to those who are critically ill. Therefore, healthcare rationing is a problem because it affects the moral judgment of a provider.
Rationing has an adverse impact on the nursing profession because it instills doubt. Since they deprive other patients of healthcare services, providers are more likely to feel bad about the situation. Dr. Pagel states, “There are arguments about valuing the young over the old that I am personally very uncomfortable with” (Fink, 2020, para 36). In support of this idea, Born and Levinson (2019), talked about rationing negatively affecting the productivity of providers. When a nurse is uncomfortable, there is a possibility of increased stress levels, which reduces their performance. For quality care, “She pulled together an ad hoc committee of doctors, ethicists, and nurses” (Fink, 2020, para 38). Rationing enables nurses to collaborate with other providers to make an informed decision. Thus, healthcare rationing promotes teamwork among professionals in the setting.
Conclusion
Healthcare rationing is problematic because it limits access to healthcare and causes ethical dilemmas. Fink together with other authors has demonstrated the negative effects of healthcare rationing. Limiting access to care can reduce the number of patients that providers are able to see and treat. There are some facilities that reduce access to resources based on age, chances of survival, underlying health issues, and many more. This complicates the delivery of care because the providers are faced with the problem of deciding who to receive care and who should not.
References
Bell, S. A., Singer, D., Solway, E., Kirch, M., Kullgren, J., & Malani, P. (2021). Predictors of emergency preparedness among older adults in the United States. Disaster Medicine and Public Health Preparedness, 15(5), 624-630. Web.
Born, K. B., & Levinson, W. (2019). Choosing wisely campaigns globally: A shared approach to tackling the problem of overuse in healthcare. Journal of General and Family Medicine, 20(1), 9-12. Web.
Fink, S. (2020). The hardest questions doctors may mace: Who will be saved? Who won’t?New York Times. Web.
Singh, J. A., & Moodley, K. (2020). Critical care triaging in the shadow of COVID-19: Ethics considerations. South African Medical Journal, 110(5), 355-359. Web.