Resource Allocation in Dermatology - Article Example

Your full April 8, Resource Allocation in Dermatology- Ethical Considerations Resource allocation means the distribution of resources in such a manner that the resources are most efficiently used in cost-effective ways. Resource allocation is a science in itself, which requires high level of expertise in order to make the best use of resources while ensuring high quality healthcare service provision at the same time. Resource allocation becomes problematic when demand is greater than supply. When resources are limited, physicians need to consider “ethically appropriate criteria” that assess the medical needs of patients, which include “likelihood of benefit, urgency of need, change in quality of life, duration of benefit, and, in some cases, the amount of resources required for successful treatment”, states the American Medical Association (para.2). In dermatology, as in any other field of medicine, ethical consideration includes prioritizing of patients on the basis of change in life quality, and not individual factors like age, gender, ability to pay, and etcetera. Recently, there has been a suggestion to use laser machines in dermatology clinics of government hospitals for cosmetic procedures which are not going to be free of cost. There is economical interest behind this step, or in easy words, government will make money by bringing laser cosmetic procedures in government hospitals and charging fee. Since resources are limited, doing so will exhaust them when they are more needed by the patients with more serious skin diseases like vitiligo. They will have to wait unnecessarily for the resources (laser machines) to be available. Hence, the problem of prioritizing the patients arises. When decision has to be made on the basis of change in quality of life, those patients must be preferred who need laser machines for more serious skin diseases. Those needing laser machines for cosmetic procedures can wait. Hence, ethical considerations need to be brought into perspective while deciding for dermatological resource allocation. The theory of "accountability for reasonableness" (A4R) as presented by Norman Daniels and James Sabin helps understand the prioritizing of patients in healthcare settings, state Hasman and Holm (261). Hasman and Holm (261) state that “A4R is designed as an institutional decision process which will ensure that only those reasons which everybody will agree are relevant and appropriate form part of decision-making.” This makes it easy to understand that when resource allocation is being decided upon, like in this case as in the allocation of laser machines in governmental hospitals, patient priority must be considered according to the A4R theory, and patient consent must be taken to ensure that all kinds of patients with all kinds of skin infections and diseases agree upon such resource allocation. Publicity, relevance, appeals, and enforcement are the four main components of the A4R theory which encourage concerned parties to challenge the decision-makers’ priority decisions. Today, people are aware of what is fair and legitimate with regard to their healthcare rights, and thus, they feel that their rights are protected when resource allocation is being done. They want transparency about the reasons the decisions are being made (publicity), and they want the decisions to be reasonable and agreeable (relevance). Patients belonging to pluralist societies have enough awareness to disagree upon the ideas and conceptions of the decision-makers regarding priority setting (appeals). All of these aspects must be ensured to guarantee patient satisfaction (enforcement). Hence, ethically speaking, the A4R theory supports the fact that dermatology patients have a right to object to the allocation of laser machines in governmental hospitals for cosmetic procedures, and they would be ethically correct in making a claim about the revision of such a decision by the government. For a layman to understand the importance of laser machines for specific dermatological processes, and to prioritize the patients based on the A4R theory, it is important to discuss when and why laser machines are used in dermatology. There are many skin diseases that require laser procedures for recovery. The word “Laser” stands for light amplification by the stimulated emission of radiation. Laser technology started around 40 years ago which contained argon and carbon dioxide for the treatment of benign “vascular birthmarks such as port-wine stains and haemangiomas” (DermNet New Zealand Trust, para.1). Side effects like scarring was observed, which led the scientists to make improvements in laser technology, and so, last 20 years have brought much improvement in the usage of laser machines to treat many serious skin infections, skin diseases, and congenital flaws which may include vascular and pigmented lesions. Vascular lesions that are treated with laser technology include superficial vascular malformations, facial telangiectases, pyogenic granulomas, Kaposi sarcoma, and poikiloderma of Civatte. Pigmented lesions that are removed or treated with laser include moles, freckles, birthmarks, congenital melanocytic naevi, blue naevi, naevi of Ota/Ito, and Becker naevi (DermNet New Zealand Trust, para.16). Now, an account of some cosmetic conditions must be given so as to make it easy to prioritize which skin conditions are important and need to be placed first when allocating laser resources. Nowadays, laser technology is being used for many cosmetic plastic surgeries like removal of tattoos, scars, and wrinkles. Facial and body hair is being removed permanently. Laser is also used in skin resurfacing and rejuvenation. There are a lot of other minor and major skin corrections that come under the heading of cosmetic surgery that require laser machines. All of these procedures are very expensive, and the patents are required to complete multiple sessions with the cosmetic surgeon till final results are achieved. This makes the procedure too lengthy and costly for a common man to afford. The above mentioned account of the usage of laser machines, both for serious skin conditions and for cosmetic surgery, makes it easy to understand which skin conditions to be given importance while allocating limited laser machine resources. The A4R theory suggests that the conditions should be prioritized so that the patients may be ranked on the basis of their medical needs. It is very easy to understand which patient to be given priority: a patient with vitiligo, or a patient who wants her facial hair removed. Obviously, the patient with vitiligo must be considered first. There are a lot of patients with serious skin conditions needing laser treatment, and only a few affording ones need cosmetic surgeries. With limited laser machine resources, it becomes hard to provide ample laser machines for both the purposes, and especially in government hospitals while charging money as well. Ethically, patients with serious skin conditions must be convinced that they would need to compromise on laser machine availability; and, if they disagree, then the A4R theory requires the decision-makers to revise their decision of supplying laser machines to the dermatology clinics in government hospitals. Resource allocation is one ethical consideration while discussing the supply of laser machines in government hospitals, and charging fee from patients is another. Government hospitals are not supposed to charge fee, and hence, this makes it an unethical practice. Kluge (para.1) describes this aspect of resource allocation in very simplified terms: When the resources are construed as social goods, allocation may proceed either in terms of competition between individuals on the basis of the relative strengths of their competing rights, or on an aggregate basis by evaluating which distribution would (be likely to) produce the greatest amount of good for the greatest number of people. When the resources are construed as commodities, the allocation problem assumes a different orientation. Notions of competing rights or of maximizing the aggregate good drop out of the picture and economic considerations take their place. Laser machines being allocated to government clinics makes laser machine resources a sort of commodity being used for personal interests or economic interests. The ability to pay will become the criteria of service provision because the basic intent behind this step is to make money for the government. When money matters come in, the real essence of healthcare service provision is forgotten, and healthcare becomes business. Kluge asserts that resource allocation in healthcare will always be a problem, because demand will always exceed supply, as healthcare providers and healthcare resources will always be limited in number. The problem can be resolved by considering competing ethical rights of patients. Putting it all together, the suggestion of providing laser machines in dermatology clinics of government hospitals must be discarded due to a myriad of ethical considerations, the biggest one of which is prioritizing the needs of patients with serious skin diseases. Decision-makers must understand that resource allocation of laser machines must be made wisely since resources are limited and demand exceeds supply. Patients with serious skin diseases must be treated on preferential basis; and, in case they disagree with the decision of compromising on laser machines availability, then the decision-makers must revise their decision of laser machines supply for cosmetic procedures in government hospitals. Also, the intention behind resource allocation should be the goodness of patients rather than making it a business by making money from cosmetic procedures in government hospitals. Resource allocation is a serious task that requires the decision-makers to consider many ethical considerations; and, the A4R theory must be followed in prioritizing patients on the basis of their medical needs and change in the quality of life. Works Cited American Medical Association. Opinion 2.03 - Allocation of Limited Medical Resources. AMA, 2014. Web. 7 Apr 2014. . DermNet New Zealand Trust. Lasers in Dermatology. DermNet NZ, 2014. Web. 8 Apr 2014. . Hasman, Andreas, and Soren Holm. “Accountability for Reasonableness: Opening the Black Box of Process.” Health Care Analysis 13.4(2005): 261-273. Kluge, Eike-Henner. “Resource Allocation in Healthcare: Implications of Models of Medicine as a Profession.” Medscape Multispecialty. WebMD LLC, 2014. Web. 7 Apr 2014. . Read More