BAnEthical Perspective ± How to Do the Right Thing
David Seedhouse
8.12 Introduction
Health care resources are scarce. This is an unfortunate fact of life. In those cases
where there are not enough to go around difficult choices must be made. Some-
times nurses must make these choices. This may mean that they cannot help
everyone they would like to. It may mean that they will not be able to offer as much
to each patient as they would ideally wish to, but this is not a perfect world. In
order not to waste resources, and in order to be as fair as possible across the health
service, all nurses must be aware that rationing is sometimes necessary. Nurses
must recognise these facts; nurses must do the right thing.
This, at least, is the official position :it is held !and fostered) by governments
preoccupied by the need to keep health care costs in check [1], by several health
economists [2], some of whom devote considerable energy to the production of
technical rationing formulae'; and it is increasingly !though often grudgingly) accepted by many nurses. Slowly but surely theofficial line' has also come to be
believed by many of the general public, who listen to the various experts and ± not
unreasonably ± conclude that if those in the know see the need to ration, then there
must indeed be such a need.
But is the official position true? Certainly not everyone accepts it. For instance, it
has been argued that the basic duty of any government must be to defend its
people against threats to life and safety, and that since in normal circumstances
health care does this much better than any other sort of public provision !and is
infinitely more useful than an idle army), governments must ± as a matter of
obligation to their subjects ± switch military funding to health services [3]. It is also
claimed that in the USA, where spending on health care consistently consumes
around 14% of the gross domestic product, there are already more than enough
health services to go round; the problem is that not everyone who needs them can
get access !millions of Americans do not have health insurance and cannot afford
to pay privately to get the help they need) [4].
It is further argued, against the official view, that the belief that the development
of new medicines and technologies must fuel growing patient demandad infinitum