Resource Allocation

Resource Allocation
Relevant Definitions
• Resource Allocation in Health Care:

• The constellation of decisions and actions that prioritize health care needs
• Rationing:
• The distribution of any needed thing or procedure that is in short supply to
those who need it in accord with a set of rules that assure fair distribution
Resource Allocation in Health Care
• The ethics of resource allocation may be considered in relation to the
concept of justice and fiduciary duty toward the patient.
• Healthcare workers should aim to safeguard the interests of patients
• A just process should be used to determine adequate level of health care
• How one decides what is fair/just can be contentious and difficult.
Ethical principles in health care resource
allocation
• In the health care ethical dilemmas discussed thus far, the focus has mainly been on
the individual patient
• In prioritizing healthcare needs, the focus of the decision shifts from the individual
patient to a group of patients or potential patients
• national population
• local community, or
• users of a specific service in an a hospital
• E.g., dialysis patients
Ethical principles in health care resource
allocation
• Autonomy
• Justice
• Beneficence
• Non-maleficence
A balance needs to be struck between respect for
individual autonomy, benefiting the whole population and
fair distribution of limited resources.
Utilitarianism and Resource Allocation
• The ethical theory that prioritizes community or
population level decisions is utilitarianism
• The ethically correct action will be that which results
in the maximum overall benefit.
• Requires a balance between the benefit to be gained

from: This Photo by Unknown Author is licensed under CC BY-SA-NC
• the improvement in health for an individual and

• the number of individuals who could benefit.
Utilitarianism and Resource Allocation
• Criticisms of this theory:

• It fails to consider the ‘need’ for healthcare intervention
• It relies rather on cost effectiveness
• For example, it may favor preventative treatment such as diabetes control compared to
renal dialysis for end stage renal disease.
The role of healthcare providers in resource
allocation and advocating for patients
AMA Opinion 2.03 - Allocation of Limited Medical Resources
“A physician has a duty to do all that he or she can for the benefit of the individual
patient. Policies for allocating limited resources have the potential to limit the ability of
physicians to fulfill this obligation to patients”
“Physicians have a responsibility to participate and to contribute their professional

expertise in order to safeguard the interests of patients in decisions made at the societal
level regarding the allocation or rationing of health resources.”
Criteria used in deciding the equitable and
appropriate allocation of resources
AMA Opinion 2.095 - The Provision of Adequate Health Care
• In determining whether particular procedures or treatments should be included in the

adequate level of health care, the AMA Code of Medical Ethics’ Opinions on
Allocating Medical Resources recommends consideration of the following ethical
principles:
1. Degree of benefit (the difference in outcome between treatment and no treatment),
2. Likelihood of benefit,
3. Duration of benefit,
4. Cost, and
5. Number of people who will benefit (referring to the fact that a treatment may benefit the patient
and others who come into contact with the patient, as with a vaccination or antimicrobial drug).
Degree of Benefit
• These criteria prioritize patients who are assessed to have a greater
likelihood of benefiting from treatment
• Should treatment be provided where the benefit is minimal?
• Also consider quality of life

Urgency of need, likelihood of benefit and
duration of benefit
• This criteria applies especially when the scarcity of the resources changes.
• E.g. Pandemic
• When resources are especially scarce, priority should be given to the sickest
patients until the scarcity situation improves.
• When consideration is given to the sickest patients, one must also consider
whether the treatment if futile.
Urgency of need, likelihood of benefit and
duration of benefit: Medical Futility
• Healthcare workers should also
consider futility of care when allocating
resources
• A judgment that further medical

treatment of a patient would not have
useful or successful results.
• This may impact on the duration in which
care is offered/given
Amount of resources required: Cost
• A key issue is the cost of the benefit achieved by the
healthcare intervention especially when resources are
limited
• This approach tend to favor resources being allocated to

less expensive treatments or services providing the greatest
benefit
• This may be a treatment that produces a large benefit for a

small number of people or a small benefit for a large group
of patients
Amount of resources required
• When resources are exceptionally scarce
• May be allocated to those who will require
less of the resource
• This maximizes the number of patients who

could benefit from the resource
• Including human resource
Number of people to benefit
• The purpose of this resource allocation system

is to maximize the use of limited resources to
provide maximum benefit to society
Analyze common ethical dilemmas
associated with resource allocation
in the healthcare setting
Sample Case that I have seen numerous times
including in USMLE type question
Ref: https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/detail/78
• A 28-year-old male is admitted with bacterial endocarditis and needs a replacement of his prosthetic
heart valve. After his first replacement, he continued to abuse intravenous drugs. The medical team
feels it would be "futile" and a waste of medical resources to replace this heart valve yet again.
• Is the team's judgment appropriate in this case?
• Case Discussion
While it is likely that this patient will require additional counseling and support services to improve
his health outcomes, replacing the heart value is not "futile" in this case (see the topic page on
Futility for further discussion). It is also likely that the medical team is using biased criteria to judge
"wasted" vs. "properly used" medical resources. Thoughtful discussion may provide an opportunity
for the team to voice their frustration and think through a treatment plan that will maximally support
this patient's recovery.

Resource Allocation

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Resource Allocation

• Resource Allocation in Health Care:

• Requires a balance between the benefit to be gained

• the improvement in health for an individual and

• Criticisms of this theory:

“Physicians have a responsibility to participate and to contribute their professional

• In determining whether particular procedures or treatments should be included in the

• Should treatment be provided where the benefit is minimal?

• Also consider quality of life

• A judgment that further medical

• This approach tend to favor resources being allocated to

• This may be a treatment that produces a large benefit for a

• This maximizes the number of patients who

• The purpose of this resource allocation system

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