Ethical Analysis of Healthcare Rationing in America

Introduction: The Healthcare Rationing Debate

The topic of healthcare rationing has been the subject of ongoing debate in the United States as government expenditures on healthcare have far exceeded budgeted levels. Central to the concern is the ethical question of whether fewer Americans should benefit from a greater share of health resource allocation, or whether the majority should benefit to a lesser degree in the interest of equity. In the essay "We've Got To Ration Health Care" (author unknown), the position is taken that America would fare better by following the approach seen in other Western countries, where it is considered preferable to ration medical procedures to the extent that a system provides "the highest possible level of basic health care that can be delivered to all the people."

With growing concern over healthcare rationing and the discussion of developing explicit government policy to govern resource allocation, the ethics of current practice in medical directives must be examined for its usefulness, its privileges, and its community benefit.

Utilitarian Ethics and Clinical Decision-Making

According to Raymond J. Devettere, a university professor in the Department of Philosophy at Emmanuel College, the rights-based utilitarian theory — which supports the "happiness" of the greatest number of individuals — can be applied to the clinical ethics perspective of healthcare rationing. He takes an Aristotelian position that the decision-maker should base his or her ethical values on patient well-being rather than on established guidelines alone. This involves incorporating the perspectives of all individuals involved: the patient, relatives, doctors, nurses, administrators, and attorneys.

This more utilitarian view, as opposed to the essayist's equity perspective, outlines a dichotomy of moral opinion relevant to healthcare rationing. To properly evaluate the reasoning of each, an ethical analysis must be applied. As scholars have noted, utilitarian ethics prioritizes outcomes that maximize overall well-being, a principle with significant implications for how medical resources are distributed.

Ethical Vulnerabilities in the Pro-Rationing Argument

By comparing Devettere's ethical principles to the anonymous essay, the morality of the argument can be examined, and several vulnerabilities in the essay's ethical justification are exposed. First, Devettere makes the point that omissions are not as easy to justify as actions. The essayist's perspective focuses on "omitting" treatments through rationing. Furthermore, the judgment of the futility of treatment is not morally conclusive and therefore should not be advanced as a reasonable argument. For instance, the concept of opting not to "throw good money after bad" by withholding medical treatment from a dying patient is lacking in ethical justification.

At the crux of the essay is the argument that guidelines for providing medical care, as set forth by some governing body, are necessary to support rationing. This is directly opposed by Devettere's theory that institutional beliefs are not necessarily rooted in ethics, and that allowing one group to decide for another what medical benefits will be permitted contradicts the morality of the whole. However, as Devettere also acknowledges, a moral disagreement does not automatically disavow the morality of the underlying ideal. The essay attempts to convey ethical reasoning but falls short of providing adequate justification. The principles of medical ethics — including autonomy, beneficence, and justice — further illuminate why omission-based rationing raises serious moral concerns.