Ethical health resources allocation: Why the distinction between ?rationing' and ?rationalization' matters
| Autor | Maria do Céu Patrão Neves |
| Cargo | Professora Catedrática de Ética, Universidade dos Açores (Portugal) |
| Páginas | 64-79 |
Maria do Céu Patrão Neves
Rev Bio y Der. 2020; 50: 63-79
www.bioeticayderecho.ub.edu - ISSN 1886-5887
| 64
Abstract
Allocation of health resources has an irreducible ethical dimension, thus cannot be decided only technically,
but must be ethically weighed, what paradigmatic experiences of macro (Oregon Ba sic Health Services Act,
prioritization criteria, and transparency in its application. In situations of aggravated resource scarcity, it is
these positions, there is a distinction between 'allocating' (resource management) from 'rationing'
(allocation of limited res ources to a limited number of persons) and 'rationalizing' (optimization of
available resources). These distinctions are ethically pertinent, showing how only 'rationalization' respects
justice, transparency and human dignity.
Keywords: allocation; rationing; rationalization; justice; transparency; human dig nity.
Resumen
La asignación de recursos de salud tiene una dimensión ética irreducible, que no se pue de solo decidirse
técnicamente, sino que debe sopesarse éticamente, lo que han demostrado experiencias paradigmát icas de
macro (Ley de Servicios Básicos de Salud de Oregon, 1989) y microasignación (Comité de Dios, 1962). Se
requiere justicia, en la enunciación de los criterios de priorización, y transparencia, en su aplicación. En
situaciones de grave escasez de recu
de recursos) del 'racionar' (asignación de recursos limitados a un número limitado de personas) y
'racionalizar' (optimización de los recursos disponibles). Estas distinciones son éticamente relevantes y
muestran cómo solo la 'racionalización' respeta la justicia, la transparencia y la dignidad humana.
Palabras clave: asignación; racionamiento; racionalización; justicia, transparencia; d ignidad humana.
Resumo
A alocação de recursos em saúde tem uma dimensão ética irredutível, não podendo ser apenas tecnicamente
decidida, mas devendo ser eticamente ponderada, o que experiências paradigmáticas de macro (Oregon
-se justiça,
na enunciação de critérios de priorização, e transparência, na sua aplica ção. Em situações de e scassez
agr
-
recursos limitados a um número limitado de
disponíveis). Estas distinções são eticamente pertinentes, evidenciando-
respeita a justiça, transparência e dignidade humana.
Palavras-chave: alocação; racionamento; racionalização; justiça; transparência ; dignidade humana.
Resum
L'assignació de recursos de sa lut te una dimensió ètica irreductible, que no es pot decidir només
s de
macro (Llei de Serveis Bàsics de Salut d'Oregon, 1989) i microassignació (Comitè de Déu, 1962). És
En
situacions de greu escassetat de recursos, és habitual interpretar 'assignar' i 'racionar' com a sinònims, o
afirmar que 'assignar' se mpre és 'racionar'. Quan e s rebutja aquesta perspectiva, hi ha una distinció entre
'assignar' (ge stió de recursos) envers 'racionar' (assignació de recursos limitats a un número limitat de
persones) i 'rac ionalitzar' (optimització dels recursos disponibles). Aquestes disti ncions són èticament
rellevants i mostren c om únicament la 'racionalització' respecta la justícia, la transparència i la dignita t
humana.
Paraules clau: assignació; racionament; racionalització; justícia, transparència; dignitat humana.
Artículo en portugués disponible en:
https://revistes.ub.edu/public/journals/35/patrao.pdf
Maria do Céu Patrão Neves
Rev Bio y Der. 2020; 50: 63-79
www.bioeticayderecho.ub.edu - ISSN 1886-5887
| 65
Broadly, resource allocation refers to the availability or distribution of existing resources, or
means of intervention, to certain sectors of activity or people (Encyclopædia Britannica online).
The same general definition applies to the scope of healthcare, in which the resources to be
allocated can be human, technical or financial, always with a significant impact on the lives of
patients and public health. In all domains considered, resource allocation refers primarily to good
management practice, regardless of the volume of existing resources.
Allocation of health resources cannot be seen as a purely technical action, carried out only
by medical imperatives (prioritizing the most severe clinical conditions), economic ones
(prioritizing the therapeutic means that produce 'more health'), administrative management
(prioritizing the options that make the existing resources more profitable), or political
considerations (prioritizing the most obvious health needs). 'Allocate', derived from the Latin
words ad (to) + locus, i (place), means etymologically 'to put in the right place', in the best place,
to which something belongs. It is therefore appropriate to say that 'allocate' has a double ethical
dimension: from an etymological-conceptual perspective, 'allocate' means to rightly place or to
give a good destiny to the available resources; from an operative perspective, it refers to the
attribution or distribution of resources to chosen 'places'. In both approaches, 'allocate' expresses
the option for the best alternative among several possibilities, an evaluation based on the criteria
of 'good' and 'evil'; thus, this option refers not only to facts, being technically decided, but also to
norms, being ethically considered.
Healthcare allocation gains a stronger expression and urgency as the scarcity of resources
deepens. This has become ever more evident, particularly since the biotechnological revolution
triggered by the discovery of the double helix structure of DNA in 1953, which created favorable
conditions for the production of advanced therapeutic technologies and innovative drugs. These
helped to cure, control or mitigate more and more pathologies, with a hitherto unseen level of
effectiveness. However, they became generally inaccessible to the majority of the population due
to the high cost with which they reached the market, and which, in turn, discouraged their
production in greater quantities. Thus, a new reality emerged that has become the contemporary
context for the allocation of healthcare resources: the existence of effective therapeutic resources
rendered inaccessible due to their price and scarcity.
It is in this context that: at the macro level, centered on healthcare services, it becomes
necessary that the entities responsible for public health make choices about the priority sectors
in which to invest; at the micro level, centered on the patients, health professionals are required
to choose the patients to whom they assign priority in accessing the limited existing resources
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