scholarly journals 1597 Navigating the Morality of Postponing Urgent Cancer Surgery in The Covid-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Tucker
Keyword(s):  
Resource Allocation ◽  
Thought Experiment ◽  
Moral Dilemmas ◽  
Best Interests ◽  
Curative Surgery ◽  
Veil Of Ignorance ◽  
Scarce Resources ◽  
Incurable Disease ◽  
Medical Need ◽  
Stage 1

Abstract Introduction The Covid-19 pandemic presents challenges of unparalleled magnitude to healthcare resource allocation. Many cancer operations have been postponed due to reduced staff, bed and ICU availability, potentially allowing incurable disease progression. The five-year survival rate for stage 1 bowel cancer is 91%; stage 2, 84%1, yet some studies suggest the mortality rate of ventilated Covid-19 patients is 50-88%2,3,4,5. Many ethical documents attempt to guide just resource allocation for ICU, however, Covid-19 presents a greater conundrum. If resource allocation occurs on the basis of acute medical need it is preferential to Covid-19 care, and at what cost is this to those with potentially curable cancer? How can we navigate pandemic pressures to be as just as we can? Method Literature review and application of ethical theories including utilitarianism, deontology and a Rawlsian approach. Results Utilitarianism argues that allocating scarce resources to those likely to gain minimal benefit, whilst removing benefit from those with a higher likelihood of survival would not be for the greater good. Doctors, however, tend to practise in a more deontological way; that is in the best interests of the patient in front of them. Rawl’s thought experiment allows us to wear a ‘veil of ignorance’ to consider the fairest decision for any undefined individual. Conclusions Covid-19 has forced unprecedented moral dilemmas; these do not just extend to patients requiring ventilators, but those in need of curative surgery. An understanding of ethical principles and a multidisciplinary approach to decision-making should encompass the consideration of outcomes of oncological surgical intervention.

scholarly journals Veil-of-Ignorance Reasoning Mitigates Self-Serving Bias in Resource Allocation During the COVID-19 Crisis

2020 ◽  
Author(s):  
Karen Huang ◽  
Regan Bernhard ◽  
Netta Barak-Corren ◽  
max bazerman ◽  
Joshua D. Greene
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Moral Reasoning ◽  
Healthcare Professionals ◽  
Decision Makers ◽  
Medical Resources ◽  
Veil Of Ignorance ◽  
Younger Patients ◽  
Scarce Resources ◽  
The Veil

The COVID-19 crisis has forced healthcare professionals to make tragic decisions concerning which patients to save. Furthermore, The COVID-19 crisis has foregrounded the influence of self-serving bias in debates on how to allocate scarce resources. A utilitarian principle favors allocating scarce resources such as ventilators toward younger patients, as this is expected to save more years of life. Some view this as ageist, instead favoring age-neutral principles, such as “first come, first served”. Which approach is fairer? The “veil of ignorance” is a moral reasoning device designed to promote impartial decision-making by reducing decision-makers’ use of potentially biasing information about who will benefit most or least from the available options. Veil-of-ignorance reasoning was originally applied by philosophers and economists to foundational questions concerning the overall organization of society. Here we apply veil-of-ignorance reasoning to the COVID-19 ventilator dilemma, asking participants which policy they would prefer if they did not know whether they are younger or older. Two studies (pre-registered; online samples; Study 1, N=414; Study 2 replication, N=1,276) show that veil-of-ignorance reasoning shifts preferences toward saving younger patients. The effect on older participants is dramatic, reversing their opposition toward favoring the young, thereby eliminating self-serving bias. These findings provide guidance on how to remove self-serving biases to healthcare policymakers and frontline personnel charged with allocating scarce medical resources during times of crisis.

Alzheimer-Erkrankungen, Autonomie und zwei Paradigmen der Pflegeethik

2018 ◽  
Vol 66 (1) ◽  
pp. 75-86
Author(s):  
Klaus-Peter Rippe
Keyword(s):  
Thought Experiment ◽  
Family Members ◽  
Best Interests ◽  
Capacity To Consent ◽  
Care Givers ◽  
Professional Care

Abstract Family members and professional care-givers are often confronted with challenging and self-destructive behaviours of people suffering from dementia, and it is not clear at all if these situations should be regulated by principles of autonomy or by principles of care, which consider the best interests of the patients. With reference to a thought experiment, this paper argues that it is not possible to control these situations by implementing principles of autonomy. Instead, while taking into account the patients’ capacity to consent, it is better to apply principles of care in challenging situations.

Lifespan Prudence

2021 ◽  
pp. 50-84
Author(s):  
Juliana Uhuru Bidadanure
Keyword(s):  
Age Groups ◽  
Age Group ◽  
Veil Of Ignorance ◽  
Scarce Resources ◽  
Unequal Treatment ◽  
Critical Engagement ◽  
Simple Realization

How should a just government distribute resources like jobs, education and healthcare between age groups? How should it ensure that the rules that govern entitlements and restrictions at different stages of our lives are fair rather than age-biased? This chapter answers these questions starting from Norman Daniels’s account of lifespan prudence. Daniels proposes that the unattractive allegory of a war between young and old could be undercut by the simple realization that we can all benefit from some forms of unequal treatment by age. He asks us to convert the interpersonal question into the intrapersonal question “how would an ideally placed agent behind a veil of ignorance distribute scarce resources between different stages of her own life?” This chapter offers an in-depth critical engagement with the framework and offers two resulting principles of age-group justice: lifespan sufficiency and lifespan efficiency.

Contractual Reconstructions

2020 ◽  
pp. 365-386
Author(s):  
Albert Weale
Keyword(s):  
Utility Theory ◽  
Large Scale ◽  
Contract Theory ◽  
Thought Experiment ◽  
Single Agent ◽  
Essential Element ◽  
Essential Elements ◽  
Veil Of Ignorance ◽  
Practical Syllogism ◽  
Mutual Advantage

In the twilight of utilitarianism contract theorist sought to respond to the problems that utilitarianism had thrown up. How successful were they? Our review of contract theory has shown that it is not possible to base a contract theory on a utility theory of rationality, even though some have claimed that such a theory states the essential elements of rational behaviour. The axioms of utility theory are controversial in themselves, and do not give an account of prudence. To have an account of prudence, we need to turn to the deliberative account of rationality, and the idea of intelligibility. The practical syllogism will only take us so far, however, and will not deal with cases where interests conflict. There is no need to make a sharp distinction between contract theories in which there is a plurality of agents, without a veil of ignorance, and a single agent behind a veil of ignorance. The singular veil of ignorance construction can be regarded as a more abstract thought experiment in situation of moral perplexity. Similarly, the distinction between mutual advantage theories, which involve essential reference to a baseline of non-cooperation, and baseline independent theories is not clear, since much depends on the character of the baseline. The problem of obligation remains unresolved, but its lack of resolution underlines a conclusion of Hart to the effect that coercion is an essential element of a large-scale society.

Bioethics in the field of pediatric surgery

2020 ◽  
Vol 69 (4) ◽  
pp. 483-492
Author(s):  
Marko Bašković ◽  
Dora Škrljak Šoša
Keyword(s):  
Decision Making ◽  
Legal System ◽  
Pediatric Surgery ◽  
Medical Decision Making ◽  
Treatment Strategies ◽  
Moral Dilemmas ◽  
The State ◽  
Best Interests ◽  
Medical Decision ◽  
Team Members

It is the professional responsibility of pediatric surgeons to follow the principles of maintaining life and alleviating suffering, often by questioning whether they have acted correctly. Apart from the moral dilemmas of choosing the best treatment strategies, they are often in dilemmas with the parents, who also involve their own “strategy” in the whole story, which they think is the most optimal treatment for their child, despite the contrary recommendations of the profession. Children, and especially adolescents, may be somewhat involved in medical decision making. Mostly the parent-physician-child / adolescent triangle agrees, but this is not always the case, which is why pediatric surgeons encounter problems. Ethical committees, composed of competent people, supported by the legal system of the state, who are able by consensus of team members to advocate and ensure the best interests of patients, must be activated for the full scope of the solution.

scholarly journals Resource Allocation After a Nuclear Detonation Incident: Unaltered Standards of Ethical Decision Making

2011 ◽  
Vol 5 (S1) ◽  
pp. S46-S53 ◽  
Author(s):  
J. Jaime Caro ◽  
Evan G. DeRenzo ◽  
C. Norman Coleman ◽  
David M. Weinstock ◽  
Ann R. Knebel
Keyword(s):  
Resource Allocation ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Clinical Status ◽  
Routine Clinical Practice ◽  
Ethical Standards ◽  
Critical Thresholds ◽  
Medical Need ◽  
Order Of Presentation ◽  
Available Resources

ABSTRACTThis article provides practical ethical guidance for clinicians making decisions after a nuclear detonation, in advance of the full establishment of a coordinated response. We argue that the utilitarian maxim of the greatest good for the greatest number, interpreted only as “the most lives saved,” needs refinement. We take the philosophical position that utilitarian efficiency should be tempered by the principle of fairness in making decisions about providing lifesaving interventions and palliation. The most practical way to achieve these goals is to mirror the ethical precepts of routine clinical practice, in which 3 factors govern resource allocation: order of presentation, patient's medical need, and effectiveness of an intervention. Although these basic ethical standards do not change, priority is given in a crisis to those at highest need in whom interventions are expected to be effective. If available resources will not be effective in meeting the need, then it is unfair to expend them and they should be allocated to another patient with high need and greater expectation for survival if treated. As shortage becomes critical, thresholds for intervention become more stringent. Although the focus of providers will be on the victims of the event, the needs of patients already receiving care before the detonation also must be considered. Those not allocated intervention must still be provided as much appropriate comfort, assistance, relief of symptoms, and explanations as possible, given the available resources. Reassessment of patients' clinical status and priority for intervention also should be conducted with regularity.(Disaster Med Public Health Preparedness. 2011;5:S46-S53)

scholarly journals Accountability for Reasonableness, for Priority Setting and Resource Allocation: A Case Scenario

2015 ◽  
Vol 6 (2) ◽  
pp. 23-25 ◽  
Author(s):  
Zoheb Rafique
Keyword(s):  
Health Care ◽  
Resource Allocation ◽  
Developing Country ◽  
Priority Setting ◽  
Case Scenario ◽  
Scarce Resources ◽  
Accountability For Reasonableness

The purpose of this paper is to discuss the accountability for reasonableness and its four conditions. This explains the priority setting and resource allocation for scarce resources. In this article it is discussed that how the scarce resources in a developing country like Pakistan be allocated in health care. This is explained with the help of case scenario.

Optimal Allocation of Worker Hours to Competing Design Projects to Meet Value Growth Targets

2015 ◽  
Author(s):  
Theodor Freiheit
Keyword(s):  
Resource Allocation ◽  
Product Development ◽  
Time Allocation ◽  
Optimal Allocation ◽  
Project Work ◽  
Scarce Resources ◽  
Lean Product Development ◽  
Design Projects ◽  
Optimized Allocation ◽  
Value Growth

Value creation is the motivating principle of lean product development processes. Set-based concurrent engineering has been proposed to improve product development efficiency and stimulate innovation. However, this approach can lead to inefficient resource utilization because it promotes the development of competitive designs, and effective worker time allocation is a real need in complex design projects. This paper looks at one aspect of resource allocation: optimally assigning limited manpower to competing design projects using a project value growth model that characterizes the translation of work-hours into developed value. While resource allocation methodologies have been proposed before, this paper adds to these efforts by including the lean principle of value together with worker capability when delivering project work and formulates the solution as a predictive control problem. The optimized allocation solution can give guidance to project managers if it is necessary to add overtime or change scheduled completion dates if target value growth is missed because of scarce resources.

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