A pivotal point of this movie which raised my ire was when a self-righteous transplant surgeon accused the HMO of committing "murder" by its refusal to bankroll a one-million dollar heart transplant procedure. Suppose the HMO officer had countered by saying: "O.K., we'll put up half the money if your team at the hospital hospital agrees to do the procedure for half price"; hopefully that would have given the doctor pause for thought - I suspect in most cases the outraged retort might have been something like "no way! we're running a hospital not a charity!" The crux of the matter is that the progress of medical science has made it technically possible to treat more and more formerly fatal conditions, but it has not made it affordable in most cases. Is any health care provider morally obligated to treat a patient regardless of cost or patient circumstances - even if it deprives other patients of the care they need? Some years ago, the British National Heath Service was excoriated by the tabloid press for refusing to finance a second bone marrow transplant for a young cancer patient whose first transplant had failed. The NHS management team replied that there was about zero chance of another transplant saving the girl's life and what right did they have to spend another million pounds on just one patient and deprive thousands of other patients the care they needed. Utilitarianism is a theory of ethics based on quantitative maximization of good for society or humanity - sometimes summarized as "The greatest good for the greatest number." All health care professionals should remember this principle; there isn't ever going to be enough cash available to do everything you would wish to do. Medical ethics become comparatively simpler in an emergency situation, e.g. a war zone or terrorism situation - doctors use the triage system, i.e. separate the wounded into three groups: (a) the seriously wounded who can be helped with the resources available (b) those with slight wounds who will survive anyway without treatment (c) those so badly injured they will inevitably die even if treated. Start with group (a), continue with group (b) if resources permit, leave group (c) to die.
