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Limiting Access to Medical Treatment in an Age of Medical Progress

  • Abstract:
    Recent developments of new and expensive methods of diagnosis and therapy have led to a constant increase of health expenditures in most industrialized countries, both in relative and absolute terms. In many countries this situation has triggered discussions about possible solutions for the resulting financial shortages in health systems, including possible limitations of access to medical services. The aim of the project was to provide an international comparison of ethical assessments of such measures and especially to find out to what degree different religious attitudes might open up diverging perspectives on the question at issue.

    Intensive care was chosen as the focal point of the study. This choice is justified, firstly, because of the considerable contribution of intensive care to health expenditures. In the USA, for instance, costs of intensive care units amount to 15-20 per cent of the budget of an average hospital, and in other industrialized countries the share is comparably high. Additionally, in intensive care there is a comparably precise prediction of therapeutical success. This means that comparing its therapeutic practice in different countries allows drawing rather precise conclusions with respect to the underlying priorities in distributing health resources.

    Participants of the project came from seven countries, belonging to four different religious confessions. Perspectives on the problem were worked out in essays, evaluated at several conferences and constantly adapted in the course of the discussion. In assessing various approaches to the possibilities of intensive care specific attention was paid to religious convictions, concerning e.g. the finiteness of human life, the sense of human suffering or the relevance of an adequate preparation for death. Concerning general ethical aspects, the prohibition to kill, the duty to solidarity as well as the right to health (care) were specifically addressed. Additionally, the use of criteria of preference and the relevance of balancing goods and evils were discussed. Criteria of distributive justice were assessed with respect to question whether they predominantly refer to resource allocation in a given hospital, to the health system of a given state or to global health care. The possible impact of the probability of therapeutic success, of patients’ burdens in the form of pain and suffering and of the financial, personal and temporal costs of provisions within the frame of distributive choices was critically evaluated.

    A profound criticism was addressed towards the concept of “futile care”: “Futile” treatments in the narrow sense of the word can be identified only in most exceptional cases. “Futility” in a wider sense, however, presupposes implicit and often controversial value judgements which should be overtly stated rather than silently introduced. Generally, limitations on medical treatments can only be acceptable when they are based on objective factual resource restraints or on consensual medical assessments, but not when they result from external restrictions. It is most desirable that allocation decisions be made transparent and thus be opened to societal discussion and value formation.

  • Members:
    Prof. H. Tristram Engelhardt Jr., Ph.D., M.D.
    Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA (Koordinator)

    Prof. Joseph Boyle
    Department of Philosophy, St. Michael's College, University of Toronto, Ontario, Kanada

    Prof. Baruch A. Brody, Ph.D.
    Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA

    Mark Cherry
    Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA

    Prof. Dr. James W. Heisig, S.V.D.
    Nanzan Institute for Religion and Culture, Nagoya, Japan

    Prof. Dr. phil. Dr. h.c. Ludger Honnefelder
    Institut für Wissenschaft und Ethik, Bonn

    Reverend Fr. Edward Hughes
    St. George Institute, Antiochian Archdiocese, Methuen, Massachusetts, USA

    Associate Prof. M. Cathleen Kaveny
    University of Notre Dame, Notre Dame, Indiana, USA

    Prof. George Khushf, Ph.D.
    Center for Bioethics, University of South Carolina, Columbia, South Carolina, USA

    Prof. B. Andrew Lustig
    Institute of Religion, Texas Medical Center, Houston, Texas, USA

    Prof. Gerald McKenny
    Department of Theology, Rice University, Houston, Texas, USA

    Associate Prof. Michael A. Rie, M.D.
    Department of Anesthesiology, University of Kentucky, Chandler Medical Center, Lexington, Kentucky, USA

    Prof. Dr. theol. Dr. med. Dietrich Rössler
    Ethik-Kommission der Medizinischen Fakultät der Universität Tübingen

    Prof. Dr. theol. Paul Schotsmans
    Centrum voor Bio-Medische Ethiek en Recht, Universität Leuven, Belgien

    Prof. Dr. Josef Seifert
    Internationale Akademie für Philosophie, Schaan, Liechtenstein

    Dr. Paulina Taboada
    Department of Internal Medicine, Center of Bioethics, Pontifical Catholic University of Chile, Santiago, Chile

    Prof. Kevin W. Wildes, S.J., Ph.D.
    Kennedy Institute of Ethics, Georgetown University, Washington, D.C., USA


  • Phase of Funding:
    August 1997 - Juli 2000


  • Publications:
    Engelhardt, Jr., H.T., Cherry, M.J. (eds.): Allocating Scarce Medical Resources. Roman Catholic Perspectives, Washington 2002.
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