Ethics of resource allocation: dimensions for healthcare executives.

WHAT IS RESOURCE ALLOCATION? Resource allocation involves the distribution of resources among competing programs or people. Although usually thought of only in the context of declining resources, resource allocation occurs when total resources are declining, stable or increasing. We hope that as the economic condition of Canada improves, the challenges will move from the former to the latter type. (1–3) Resource allocation occurs simultaneously at several levels. First, governments decide how much to spend on health, and how to spend these resources. Second, governments may receive advice, such as on cardiac care from the Cardiac Care Network of Ontario, or they may delegate management of certain aspects of the system, such as parts of cancer care to Cancer Care Ontario. Third, in provinces with decentralized systems, regional health authorities make their allocation decisions. Fourth, senior healthcare executives decide how much to spend on various hospital programs and services. Fifth, program managers decide how to allocate available resources among patients. It is likely that each of these levels of decision making has particular nuances. For instance, in this article, we are focused on decision making by senior managers in hospitals, where mission will be a prominent element. Not every ethical issue in a hospital is related to resource allocation. Conflict-of-interest policies in purchasing, the business and ethical challenges at the private/public interface, mergers and alliances, and human resource management represent issues other than resource allocation which are of great importance in hospitals. The fact remains that economic exigencies will continue. The demand for healthcare exceeds affordable supply in every healthcare system in the world, and so resource-allocation decisions are inevitable. The goal becomes to make these decisions fairly. We therefore need to explore ways in which the allocation of resources can be made more consistent with ethical reasoning. It is in everyone’s interest to practise ethical decision making whenever possible. Among other things, it shows respect for the interests of all those affected by the decision and a willingness to recognize that another’s interests are as important as one’s own.(4)