Etyka

Fair Division of Medical Means.
The problem of priorities in medicine.

Taking into account the main tasks of contemporary medicine, we should consider two definitions: according to one doctor: The main tasks of a doctor is to further enable his patients to use harmful pleasures of life such as smoking, drinking alcohol, overeating but not allowing them to die sooner than it is necessary; WHO definition is as following: Health is the state of feeling excellent physically, mentally and socially. It is not only the lack of disease or disability. The doctor presents the minimalist point of view in which he perceives a doctor as a technician operating human machine and who is the only responsible one for “it”. The second approach originates from the maximalist aspect in which everyone is responsible morally for their own health and the model of health means overall, social good state of individuals. The weight of medicine is brought on teaching and prevention.
How to divide medical means, taking into account common or individual goals? Symbolic and symptomatic is an example of Frederick West who had the heart transplanted for the first time in the UK. The hospital equipment was so limited that his operation forced to postpone several others just because the only sterile place for after operation care for West was an operating theatre where he had received new heart. However, was it possible to avoid such ambiguous situation?
Comparing human needs, there always appear the problem of priorities. Obviously, this case seems to be worth sacrifices and brought a lot of good not only to the patient but also to the science. However, whenever appear the limit of means saving life utilitarian theory of justice serves. Who should the doctor save among 3 people when we have one medicine? Suggesting maximizing happiness, one should choose the youngest that will live longer; the need of treatment- the sickest; the advantage- the best because good people deserve to be sympathetically treated. The most appropriate criterion seems to be the need of treatment since life prolonging, elimination of disease and restoring health and improving the quality of life means easing the pain and further development. But how to hierarchize these terms and how do we understand them? Accepting the necessity of the criterion of the need of treatment for fair division of medical means one cannot avoid the need of revealing moral principles. This criterion, which at first glance seems to be obvious does not make a choice easier among candidates whose medicinal needs are indisputable.
The success of treatment plus the criterion of effectiveness should also be considered. One can often meet with the opinion that the medical means could be divided according to the probability of medical success. There happen to be simple cases where the criteria are clear. It would be absurd and unjust to transfuse 1,5l of rare-group blood (the only one which is available then) to the patient with other blood group not to the one who has the right group. However, by this criterion there appear additional problems such as how to measure the success? The economists use the method of converting the life years on the “qualitative ones”.
The third element of analysis concerns the advantages that may come from the one who is saved. The other criterion refer to the future, but this one to the past. A doctor would choose a man who is able to continue his job or a married woman having small children, not an unemployed worker without a permanent dwelling place. Quite recently a man who was described as numb, aggressive, dirty, unable to control his physiological acts, masturbing himself during doctor exams has been cut from dialysis which was justified as the “patient’s interest”. To what degree the cause of the decision was demention of the patient, and to what degree his reprehensible behaviour? Should personal and social advantages and disadvantages of the patient influence on the use of the therapy saving his life?
It is not surprising that the ongoing battle, of which moral values should be the first by the division of medical means, is often passed over since doctors generally endeavour to do their best to save their own patients. One idea to cut the bone of contention claims that when there is no enough means for everyone, nobody should receive help. Two American theologians Ramsey and Childress claim that after initial assessment of the wide-understood doctor’s orders, medical means should be later divided at random or by sequence of applications. But trying to do everything to avoid dishonesty by the access to confidential information.
Yet, the satisfactory and consequent admittance of limited means has not been found. The suggestion made by Calabrisy and Bobbit: “Societies choosing various approaches try to limit destructive consequences of tragic choices between fundamental moral values” seems to be acceptable. At first one value, then the other one achieves the primacy; however any of them can be neglected for too long. Justice in spite of all, is the method of morally solving the problem of competing claims. If the system of practical settling conflicts was created to which value would be recognized at first in certain case and fundamental moral values, respectability of autonomy, charity, and “non nocere” Aristotle’s principle were taken into account, it would be fair enough to pronounce a just sentence in spite of the accompanying conflicts. Nothing more can be achieved. But is this possible?