HCA 415 Module 4 Justice and Scarce Resources Example

Forty Courses, Three Hundred Patients: Justice in Allocating a Scarce Treatment

Student Name

Health Care Administration Program, Aspen University

HCA 415: Healthcare Ethics

Instructor Name

Month Day, Year

Forty Courses, Three Hundred Patients: Justice in Allocating a Scarce Treatment

When a treatment is scarce, someone must decide who receives it. Those decisions raise questions of justice: what counts as a fair distribution, and who should decide. This paper analyzes a composite allocation decision at a regional health system and applies published principles for allocating scarce medical interventions.

The Scenario

During a respiratory virus surge, a regional health system received 40 courses of a new antiviral that reduces hospitalization when started early in high-risk patients. About 300 patients met eligibility criteria in the first week. Supplies would not increase for several weeks. The chief medical officer convened an allocation committee of clinicians, an ethicist, an administrator and a community representative.

What Justice Requires

Distributive justice concerns the fair allocation of benefits and burdens. Different theories stress equality, need, contribution or maximizing welfare, and health care ethics usually combines several considerations rather than relying on one (Beauchamp & Childress, 2019). The committee's task was to choose and weigh them explicitly.

Allocation Principles

Persad and colleagues sorted allocation rules into four families, equal treatment, priority to the worst off, maximizing benefit and social usefulness, and concluded that sound systems must blend rules from several families because none works alone (Persad et al., 2009). The table applies them to the antiviral.

Why First Come, First Served Fails

First come, first served seems equal but favors those with transportation, flexible jobs, internet access and good information, often not the sickest or most disadvantaged. The committee rejected it. Pandemic allocation guidance likewise advised against first-come allocation for scarce interventions (Emanuel et al., 2020).

Maximizing Benefits

Because the antiviral's benefit was greatest in those at highest risk of hospitalization, the committee gave priority to patients with the highest predicted risk based on age, immune status and specific conditions. This combines maximizing benefit with favoring those worst off in terms of risk. Guidance on pandemic allocation similarly emphasized maximizing benefits, including saving the most lives (Emanuel et al., 2020).

Health Workers

Some frameworks give priority to health workers, both because they keep others alive and because they take risks for others. The committee included this principle for staff in direct patient care who met high-risk criteria, reasoning that their illness would reduce care for many others.

Lotteries Among Equals

After applying risk tiers, the top tier still contained 65 patients for 40 courses. The committee used a lottery within the tier, reasoning that when claims are equal, a random draw treats people fairly and avoids bias in judgments of worth.

Avoiding Unjust Criteria

The committee excluded criteria that reflect or reinforce injustice: ability to pay, insurance status, social status, perceived worth and disability unrelated to short-term benefit. It also examined whether risk scores disadvantaged groups with less access to diagnosis, adding a review step for patients who might be under-scored.

Transparency and Appeals

Fair process matters as much as fair criteria. The committee published its criteria on the health system's website, informed clinicians how to refer patients, allowed appeals within 24 hours and documented every decision. Transparency builds public trust, and appeals catch errors.

The Final Policy

The policy set eligibility by approved indications, ranked eligible patients into three risk tiers, gave health workers in direct care equal standing within their tier, used lotteries within tiers when supply ran short and reserved two courses weekly for appeals. It was reviewed weekly as supply and evidence changed.

Counterarguments

Some argued that lotteries are cold and that clinicians should decide case by case. But case-by-case decisions by individual clinicians risk inconsistency and bias. Others argued that priority for health workers is self-serving; the committee limited it to staff in direct care who met the same risk criteria. Debating counterarguments openly improved the policy.

Lessons for Administrators

Administrators may face scarcity in drugs, staff, beds or appointments. The lessons apply broadly: define the goal, choose principles explicitly, avoid unjust criteria, use lotteries among equals, be transparent, allow appeals and revisit decisions as conditions change.

Community Voice

The committee included a community representative because allocation decisions affect people who rarely sit on hospital committees. The representative raised concerns about patients without primary care physicians who might never be referred. The committee added a pathway for urgent care centers and community clinics to refer eligible patients, widening access.

Communicating Decisions to Patients

Patients who did not receive the antiviral were told why, in plain language, with an explanation of the criteria and the lottery and advice about other treatment and warning signs. Honest communication, even when the answer is no, respects patients and maintains trust in the system.

Monitoring for Fairness

After the first two weeks, the committee reviewed who received the treatment by age, race, ethnicity, insurance and zip code. It found that patients from two rural counties were underrepresented among referrals and asked clinicians there to review eligible patients. Monitoring outcomes is part of fair allocation.

Allocation Beyond Crises

Scarcity is not limited to pandemics. Organ transplantation, specialist appointments, staff time and budget dollars are all allocated every day, often without explicit principles. The committee's approach, naming principles, avoiding unjust criteria and being transparent, can guide these routine decisions as well.

The Complete Lives Approach

One proposed system, the complete lives approach, gives priority to younger people who have not yet lived a full life while also weighing prognosis, saving the most lives, lottery and instrumental value (Persad et al., 2009). The committee discussed it but chose not to use age alone, since the antiviral's benefit depended mainly on risk rather than years of life remaining.

Conclusion

Allocating 40 antiviral courses among 300 eligible patients required combining principles: maximizing benefit by prioritizing those at highest risk, favoring the worst off, recognizing health workers' role and using lotteries among equals. Published frameworks provided a structure, and transparency and appeals made the process fair. Justice in scarcity is achieved not by a single rule but by explicit, accountable choices.

References

Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.

Emanuel, E. J., Persad, G., Upshur, R., Thome, B., Parker, M., Glickman, A., Zhang, C., Boyle, C., Smith, M., & Phillips, J. P. (2020). Fair allocation of scarce medical resources in the time of Covid-19. New England Journal of Medicine, 382(21), 2049-2055. https://doi.org/10.1056/NEJMsb2005114

Persad, G., Wertheimer, A., & Emanuel, E. J. (2009). Principles for allocation of scarce medical interventions. The Lancet, 373(9661), 423-431. https://doi.org/10.1016/S0140-6736(09)60137-9