Micro-Allocation
In the scheme of things the debate that Warren, Doran, and Patrick (Larry, Moe, and Curly would have been better) undergo regarding how limited resources should allocated in the medical field is in effect a "catch 22" situation. If any nurse or physician in a situation in line with the one Alice and Gurpreet were in such as being in a small rural area, everybody knows everybody, massive emergency situation, people with the same level of need and urgency, temporarily depleted resource base, etc., there would be no course of action that will satisfy every point-of-view under every outcome with the exception of one where everybody receiving the resources ends up with the best possible result. In effect the people who make these decisions make snap decisions based on a combination of their subjective views, training, and assessment of the relevant variables. Decisions like this are often based on mental heuristics, which are inevitably flawed in making decisions whose outcomes are ruled by probabilities. The person making the decision will later rationalize their decision from a totally different point-of-view than the one under which the decision was made. Snap decisions are made by one set of mental faculties (automatic mental processes); whereas rationalizations are made by the other set of mental processes (control mental processes). In the end, the outcome dictates the validity of the choices made. In current debate, if no one died and everyone came out of the emergency with the best possible result there would be little debate on the decisions made regarding who got treated first. However, that scenario is one many possible outcomes and the probability that it would occur is most likely very small (if it...
Having stated that there major flaws in the thinking of all parties involved.
First, the "worst first" scenario is indeed a standard in ED care; however, the key to actually applying it is Patrick's notion of impartiality, which is freedom from bias. Unfortunately, Patrick slips up when he states that these allocations should "usually" be impartial (what?) but at times should be consistent with human sympathy (huh?). So in effect Patrick is saying that decisions regarding the allocation of limited resources should be impartial when they are not biased. Well thank you Patrick. This really gets messed up when we have the worst first, first come first serve, hopeless second scenario. Technically a hopeless patient is worse than a non-hopeless patient and the designation of hopelessness is more often than not a value judgment. In a snap decision, without established protocols, deciding what patients are hopeless and what patients are not is a subjective decision made by the decision maker. In fact, the ideas of mitigating factors, excuses, and justifications all stem from subjective points-of-view. While I agree with the chapter's statement impartiality is often wrongly equated with fairness, it is also the case that when there is a micro-allocation of resources in an ER the only fair protocol is one of impartiality based on a strict decision tree. Fairness is really a subjective term and in order for such a distribution to truly offer valid considerations to everyone involved it must be impartial. In other in others the only allocation that is objectively fair by definition is one that is impartial.
From a true…
