Ethics of Rationing

Question 1

What is rationing?

Answer 1

Fair distribution of resources that are scarce

Question 2

When does rationing happen?

Answer 2

When things are scarce

Question 3

What is an example of rationing in the UK?

Answer 3

Covid-19

Question 4

How many ICU ventilators does the UK possess?

Answer 4

30 per 100,000

Question 5

What were rationing concerns in the pandemic? (6)

Answer 5

• PPE
• Ventilators
• Dialysis
• Testing and vaccines
• Displaced activity e.g. screening, surgery
• Elective waiting lists

Question 6

What did covid-19 teach us about rationing? (2)

Answer 6

• Means of fair distribution of things that are scarce
• Should be planned for

Question 7

What are the three certainties in life?

Answer 7

• Death
• Taxes
• Scarcity of resources

Question 8

What are the causes of scarcity in healthcare? (4)

Answer 8

• Advances in medical technology
• Demographic trends - ‘greying population’
• Budget restrictions
• Public expectations

Question 9

Before the NHS, what was healthcare rationed by?

Answer 9

Price

Question 10

Who rations healthcare?

Answer 10

Central government decides funding for NHS

Question 11

Who allocates the NHS budget? (2)

Answer 11

• 42 integrated care systems
• On the basis of need

Question 12

Who rations patient access to care? (2)

Answer 12

• Doctors
• Other allied healthcare professionals

Question 13

Who are primary rationing agents?

Answer 13

Doctors

Question 14

How should healthcare be rationed? (4)

Answer 14

• Hippocratic oath
• Lasagna Oath (1964)
• World Medical Association codes of ethics
• CMC

Question 15

What is the Hippocratic tradition?

Answer 15

Maximising the benefits of care for the individual patient in your care

Question 16

What is the economic perspective?

Answer 16

Consider both costs and benefits of treatment choices (including doing nothing)

Question 17

What are the principles of rationing healthcare? (3)

Answer 17

• Ability to pay
• Need or benefit
• Social values

Question 18

What do the NHS ration by?

Answer 18

Need

Question 19

What is a need for medical care?

Answer 19

A need for care exists when there is an effective and acceptable treatment for cure

Question 20

What did NICE originally stand for?

Answer 20

National Institute for Cost Effectiveness

Question 21

What does NICE stand for now?

Answer 21

National Institute for Health and Care Excellence

Question 22

What is the role of NICE?

Answer 22

Explicit device for rationing healthcare

Question 23

What is the cut off for cost of QALY?

Answer 23

£20,000-£30,000

Question 24

Who argued age is an appropriate criterion for rationing? (2)

Answer 24

• Callahan - for longer life
• Williams - fair innings approach