Academic literature on the topic 'Resource allocation Victoria Moral and ethical aspects'

Despite the revival of interest in nineteenth century psychology and ethics in Britain during the 1980s, and the current debate around Utilitarian ethics in medicine (Buckle, 2005) and care (Offer, 2004), Utilitarian premises, understood as a psychological theory rather than as a moral philosophy, remain largely dormant in contemporary British Psychology. This is so despite their apparent survival in Behaviourism (Plaud & Vogeltanz, 1994).This article examines aspects of their decline within Victorian psychology, by focussing upon the relatively neglected psychological writings of Herbert Spencer. In doing so, it seeks to make a modest contribution to unravelling the complex changes in the nature of nineteenth-century psychology. In particular it is argued that, whilst some explanations of the decline of Utilitarian premises in the Victorian development of psychology focus upon the later part of the century and cultural or institutional factors, an examination of Spencer’s works at the mid-century supports the view that changes were under way earlier. Whilst several explanations might be offered for this, changes in economic organisation and in the experience of individual agency are highlighted.The relation between Utilitarian psychology and Utilitarian ethics will then be considered. Finally, at this stage it should be possible to comment upon the significance of the marginalization of Utilitarian premises within the development of Victorian psychology for the contemporary debate about health resource allocation.

The COVID-19 pandemic has placed an enormous burden on health systems, and guidelines have been developed to help healthcare practitioners when resource shortage imposes the choice on who to treat. However, little is known on the public perception of these guidelines and the underlying moral principles. Here, we assess on a sample of 1033 American citizens’ moral views and agreement with proposed guidelines. We find substantial heterogeneity in citizens’ moral principles, often not in line with the guidelines recommendations. As the guidelines are likely to directly affect a considerable number of citizens, our results call for policy interventions to inform people on the ethical rationale behind physicians or triage committees decisions to avoid resentment and feelings of unfairness.

Ethical issues about children’s rights in respect of matters concerning resource allocation or treatment opportunities are now a matter for public consumption and concern. Alongside this exists a long-frustrated desire by children’s nurses to promote children’s health. Long-held assumptions about the legal and moral status of children within the health care system in this country are now rightly scrutinized and challenged. Those of us who claim to represent children now possess an opportunity to exploit public attention for the benefit of these children. This article will explore selected major relevant legal and moral concepts that relate to children with the aim of making transparent some of the important and often confusing information available. It is anticipated that debates about the legal and ethical status of children may be stimulated and fuelled from the following discussion. It is strongly recommended that entering into dialogue with families and children about their perceived needs will go a long way towards advancing thoughtful nursing care of individual children, their families and the general population.

Lack of resources available in intensive care units (ICU) during the COVID-19 pandemic requires bioethical guidance to respond to dilemmas presented in health teams. A person-centered ethical analysis (PCEA) for ICU clinicians, becomes the best alternative to morally justify extreme decision-making in the scarcity of available resources. The goal is to make a selection based on bioethical and clinical criteria, considering a holistic view of the person, and not just a utilitarian or first-come, first-served criterion as the one set out by colleagues from Oxford University, known as RAPR (Resource Adjusted Probability Ratio) ethical algorithm for rationing life-sustaining treatment during the COVID-19 pandemic. For this reason, fundamental bioethical principles emphasizing therapeutic proportionality and how to make an appropriate moral judgment that conveys to a sensible decision-making ethically grounded are explained, considering a flow chart proposed by colleagues from the Pontifical Catholic University of Chile. In this paper we propose the PCEA Algorithm to assist ICU teams in decision making regarding fair resource allocation and care delivery during an overwhelming pandemic scenario.

OBJECTIVES/GOALS: Innovative educational approaches and training modalities are important for training a diverse workforce in the authentic skills needed to advance all phases of clinical and translational research. Endeavors to study and develop policies that promote the translational science spectrum are steeped in value judgments. Learning how to navigate moral ambiguity and ethical reasoning enlightens our understanding of stakeholder obligations, roles and responsibilities. Ethics education can be challenging if learners are insufficiently engaged in the necessary critical reflection. In this course, decision-making in public health is informed through the analysis of the ethical issues, developing alternative courses of action and providing justification for actions taken in response to real-world dilemmas. The course is provided to students with a variety of backgrounds (science, health, policy) in a Master of Public Health degree program. Course objective were to: 1) Identify ethical issues in public health policy, practice, and research using appropriate concepts and terms; 2) Recognize the full spectrum of determinants of health and related information needed to resolve ethical conflicts in public health policy, practice, and research; 3) Present varied and complex information in written and oral formats; 4) Assess potential solutions to ethical conflicts in public health policy, practice, and research and 5) Decide ethical courses of action for public health policy, practice, and research. We adopted an open pedagogy as a guiding praxis to inform public health ethics discourse amongst our learners. In this way, learner agency was maximized to develop course materials within a generalized framework and shared with each other through the perspectives of each individual. The goal was to not only analyze complex ethical dimensions of public health issues but also gain insights into the disciplinary lenses of one’s peers. METHODS/STUDY POPULATION: Each week was divided into two sessions, a seminar and workshop. Course instructors introduce topics in a one-hour session and then allow students to decide what information is needed for a second session where the ethical issues of the topic will be discussed. Information-gathering tasks are then distributed amongst students in areas that are not their specialty, e.g. social history to be researched by learner with a biology background. The second session then involves the reporting back of background information by each student and a discussion of the ethical issues that arise. Through this process, the ability to communicate with others in different disciplines is supported, while exploring other disciplines and then engaging in ethical discussion and reasoning. Topics were introduced during the seminar session each week over the span of five weeks: 1) global public health, 2) disease prevention & control, 3) environmental & occupational public health, 4) resource allocation & priority setting and 5) research ethics. Learners were tasked with identifying the needed information to address the ethical, policy, and research aspects of the public health question(s) presented in these seminars. Students independently submitted resources they discovered to course instructors prior to the workshop. The following session began with a workshop where learners briefly presented their findings and deliberated on specific facets of the public health issue from that previous seminar while discussing a specific case. Students were assessed on their preparation (submission of identified resources), workshop presentation and participation. Research Preparation: In each seminar, the class decided what key information would be required to support the discussion at the workshop, which revolved around a relevant case study on that week’s topic. Course instructors facilitated the groups identification of material to be researched and the delegation of tasks within the group. Each student submitted a summary document (template provided) to course instructors prior to class for their area of research related to the case. Research Presentation: At the beginning of each workshop, each student was asked to present the research work to the rest of the class so that everyone has the same information for the case study discussion. These short (5-10 minutes) presentations followed the format of the preparation summary. Participation/collaboration: Both the seminar and the workshop asked students to be active learners within the class, participating in discussion, strategizing for information-gathering tasks, presenting researched material and arguments to others, and participating in case study discussion. Participation was assessed in relation to the value of the contributions made by students. RESULTS/ANTICIPATED RESULTS: The open pedagogy allowed the learners to construct the necessary materials to discuss issues with each other and develop not only a deeper understanding of the ethical dimension of public health issues but a shared understanding of each other’s disciplinary lenses. Course feedback was generally very positive, with learners either agreeing (33%) or strongly agreeing (67%) that the course was effective overall. In asking what learners liked best about the course, some indicated the “open pedagogy learning style” and “I liked the discussion format.” The positive comments mostly highlighted the discussion format. Areas for improvement noted by the learners included wanting “a longer course to cover more topics” and that the material was covered in “too short a time frame.” Other comments included that the course “was a bit disorganized” or that “the discussions were not very structured.” While the discussions by their very nature were unstructured, there is opportunity to refine this pedagogy to find right balance of learner agency. DISCUSSION/SIGNIFICANCE OF IMPACT: The goal of this teaching method was to empower the learner with the important critical thinking skills to navigate challenging ethical dilemmas in public health they may encounter in their careers. These skills include the identification of the ethical or moral conflict(s), collecting the necessary information to examine/resolve the dilemma, think creatively about the information that is unavailable and how to discuss/disseminate information to a broad constituency. This an educational model that is easily adaptable for learners working in other areas of the translational research spectrum, e.g. basic, pre-clinical, clinical and implementation sciences.

Abstract This article approaches the ethical dilemma of healthcare allocation and rationing from the perspective of pragmatist ethics, mainly following John Dewey’s ethics. The moral dilemma of healthcare allocation arises whenever we allocate limited resources, and rationing is a necessary option for distributing available resources. In a broader sense, the moral problems of healthcare allocation also encompass the issue of access to primary healthcare, especially for low-income sections of communities. In this sense, allocation always entails rationing – denying service to someone for the benefit of others. Such aspects of allocation and rationing and the relational aspect of disease and health make the problem morally controversial, which makes it difficult to agree on a principle or principles of allocation and rationing applicable across different contexts. Hence, this paper argues that moral challenges of healthcare rationing ought not to be addressed through the appeal to principles, but rather through deliberation that embraces a more pragmatic and democratic approach to negotiating health resource allocation and rationing. However, this does not mean that moral principles and values are insignificant in healthcare allocation.

Abstract Background Under COVID-19 pandemic, many organizations developed guidelines to deal with the ethical aspects of resources allocation. This study describes the results of an argument-based review of ethical guidelines developed at the European level. It aims to increase knowledge and awareness about the moral relevance of the outbreak, especially as regards the balance of equity and dignity in clinical practice and patient’s care. Method According to the argument-based review framework, we started our research from the following two questions: what are the ethical principles adopted by the ethical guidelines produced at the beginning of the COVID-19 outbreak related to resource allocation? And what are the practical consequences in terms of 'priority' of access, access criteria, management of the decision-making process and patient care? Results Twenty-two ethical guidelines met our inclusion criteria and the results of our analysis are organized into 4 ethical concepts and related arguments: the equity principle and emerging ethical theories; triage criteria; respecting patient’s dignity, and decision making and quality of care. Conclusion Further studies can investigate the practical consequences of the application of the guidelines described, in terms of quality of care and health care professionals’ moral distress.

Objective To develop an ethically, legally, and clinically appropriate ventilator allocation policy for AdventHealth Tampa and AdventHealth Carrollwood in Tampa, Florida, which could be enacted swiftly during the Covid-19 pandemic. Methods During Spring 2020, a subcommittee of the Medical Ethics Committee established consensus on the fundamental principles of the policy, then built on existing ethical, legal, and clinical guidance. Results The plan was finalized in May 2020. The plan triages patients based on exclusion criteria (imminent mortality), prognosis and expected benefit of ventilation (using the Sequential Organ Failure Assessment), and change in prognosis over time. Decisions are made by committee in order to minimize moral distress among individual patient care providers. Conclusions Due to international concerns about healthcare resource shortages during the Covid-19 pandemic, hospitals need allocation policies informed by the crisis standard of care, the hospital’s ethical duty to plan for an emergency, and federal civil rights laws Policy Implications: This type of policy can serve as a model for other institutions to develop crisis standards of care resource allocation policies, which are a necessary component of disaster planning.

Background and aim Healthcare professionals are regularly exposed to moral challenges in patient care potentially compromising quality of care and safety of patients. Preventive clinical ethics support aims to identify and address moral problems in patient care at an early stage of their development. This study investigates the occurrence, risk factors, early indicators, decision parameters, consequences and preventive measures of moral problems. Method Semi-structured expert interviews were conducted with 20 interprofessional healthcare professionals from 2 university hospitals in Basel, Switzerland. A Likert scale questionnaire was completed by the interviewees and analysed using descriptive and inferential statistics. Results Healthcare professionals are frequently exposed to a variety of moral problems, such as end-of-life decisions, resource allocation and assessing the patient's will or decisional capacity. Thirty-four different risk factors for moral problems are identified, e.g. patient vulnerability, divergent values or world views, inadequate resources or poor ethical climate. Twenty-one early indicators are recognised such as disagreement between healthcare professionals, patients and relatives, emotional disturbances, gut feeling or conflict of conscience. A variety of preventive measures are suggested and presented in a preventive clinical ethics support process model. The most helpful measures are early ethical conversations with colleagues, early team-internal ethical case discussions and an ethics-trained contact person on the ward. Ethics training, kerbside consultations, proactive ethics consultations, ethics screening and rounds are also considered helpful. Conclusions Clinical ethics support services should not only offer reactive and complex, but also proactive and low-threshold support for healthcare professionals, patients and relatives.

Abstract Background Deciding whether to resuscitate extremely preterm infants (EPIs) is clinically and ethically problematic. The aim of the study was to understand neonatologists’ clinical–ethical decision-making for resuscitation of EPIs. Methods We conducted a qualitative study in Belgium, following a constructivist account of the Grounded Theory. We conducted 20 in-depth, face-to-face, semi-structured interviews with neonatologists. Data analysis followed the qualitative analysis guide of Leuven. Results The main principles guiding participants’ decision-making were EPIs’ best interest and respect for parents’ autonomy. Participants agreed that justice as resource allocation should not be considered in resuscitation decision-making. The main ethical challenge for participants was dealing with the conflict between EPIs’ best interest and respect for parents’ autonomy. This conflict was most prominent when parents and clinicians disagreed about births within the gray zone (24–25 weeks). Participants’ coping strategies included setting limits on extent of EPI care provided and rigidly following established guidelines. However, these strategies were not always feasible or successful. Although rare, these situations often led to long-lasting moral distress. Conclusions Participants’ clinical–ethical reasoning for resuscitation of EPIs can be mainly characterized as an attempt to balance EPIs’ best interest and respect for parents’ autonomy. This approach could explain why neonatologists considered conflicts between these principles as their main ethical challenge and why lack of resolution increases the risk of moral distress. Therefore, more research is needed to better understand moral distress in EPI resuscitation decisions. Clinical Trial Registration: The study received ethical approval from the ethics committee of UZ/KU Leuven (S62867). Confidentiality of personal information and anonymity was guaranteed in accordance with the General Data Protection Regulation of 25 May 2018.

The purpose of this work is to show the importance of ethical consistency and its application in the decision-making process when allocating health care resources with respect to the Canada Health Act. Based on the specific decisions in its history and the development of its principles, I suggest that the Act can be interpreted as indicating a particular moral basis and that this could have an influence on how resources are allocated. I will focus on three claims supporting the argument that services can be delivered in a consistent and methodical manner that respects this particular moral foundation. First, the outcomes of decisions justified by simultaneous use of logically incompatible and distinct moral theories are problematic. I suggest that an approach to reasoning that uses one type of moral theory throughout the decision-making process results in less ambiguous outcomes. Second, based on key points in the history of the Canada Health Act, I believe there is a moral theory, deontological in nature, and that it captures the spirit behind the Act's development and current formulation. Third, decision-makers in Canada should follow one deontological theory when allocating health care resources to avoid inconsistencies, and to work within the moral framework of the Act as I have interpreted it. A delivery system that consistently follows this procedure may have different outcomes than the current methods of macro-allocation, and these differences may have effects on the amount and availability of health care services.

Sometimes distributional schemes for scarce goods and public roles include a lottery element. Lottery schemes are seen in a variety of contexts, from the selection of jurors and the conscription of soldiers, to the allocation of educational places and affordable housing. The use of lotteries in our allocative practices provokes two questions. First, what exactly is the practice of allocation by lottery, and how widespread and important is it? Second, under what circumstances and why would it be justifiable to use a lottery in a distributive scheme? The first part of this dissertation - which includes Chapters 1 and 2 - is devoted to answer-ing the first question. Chapter 1 gives an overview of the main applications and most important examples of allocation by lottery. It shows that lottery schemes have been and still are employed in a wide variety of, often very important, public choices. It also emphasizes the great variety in the details of lottery schemes, and their frequently high degree of complexity. Chapter 2 provides a characterization of a lottery, and distinguishes equiprobable from weighted lotteries. It argues that the process employed in any lottery has five main characteristics, and that the process's probabilities might be interpreted in multiple ways. I also introduce a distinction between simple and complex lotteries, and stress that a complex lottery can provide participants with unequal probabilities of success without being weighted. The second part of this dissertation-which includes Chapters 3, 4, 5, and 6 - covers various topics regarding when and why we would want to employ a lottery. Chapter 3 considers what general approach we should take to justifying lotteries. I argue for pluralism in the justification of lotteries: there will be varied and multiple reasons that can justify lotteries in different contexts, and these reasons are often grounded in the interplay between different institutional features. Chapter 4 analyzes what types of distributive procedures might be appropriate when claims to a scarce good are equal. I contend that only certain lottery procedures seem to fully respect equal claimants, because they are fair and meet other relevant standards for treating claimants properly. Additionally, I argue that in many, if not all cases, it would be fairer not to allocate the scarce good at all, rather than to hold a lottery. Chapter 5 entertains the position that a lottery's contribution to fairness plays a main role in its general justifiability. I maintain that this position is only plausible, if the contribution of lotteries to fairness is understood pluralistically and not exclusively related to respecting equal claims. I identify two additional ways of how lotteries might be understood to contribute to fairness. Chapter 6 considers whether inadequate epistemic capacity can ground the claim that all proposals for randomly selected citizen assemblies are epistemically indefensible. I argue that, with the appropriate design, a citizen assembly would at least not have substantially worse epistemic capacity than an elected assembly, and that it may even have more epistemic capacity given its advantage in terms of diversity.