Allocation of Scarce Resources – Jewish Perspectives

Rapid developments in medicine and medical technology during recent years have created a variety of ethical dilemmas including the allocation of limited or scarce resources such as money, instruments, medications, health-care facilities, time and manpower. This is quite a new dilemma, which has been created due to the advancements in very expensive scientific and technological measures. No country in the world can provide all the medical needs for all its citizens. Therefore, public policies relating to priorities in allocation have become necessary. The issue is both economic – how to allocate the limited resources most beneficently, and ethical – how to allocate these limited resources in a most equitable and just manner. There are two different aspects to this issue: Macro-allocation -involving society as a whole; and Micro-allocation -involving individual health care providers. In this article I shall discuss the macro-allocation, namely the ethics of the distributive justice of limited societal resources, general health-care policies, and the effects of budgetary and economic decisions on medical practice. The dilemmas and solutions concerning situations of micro-allocation and triage decisions are quite different and deserve a separate and specific discussion. HISTORICAL BACKGROUND In the past, in the developed world, if a medical treatment or intervention for a patient was considered useful, it was done. The questions at that time were whether or not the procedure was beneficial, safe, and widely accepted. Nowadays, because of rapid advances in medicine, additional questions of feasibility and cost exist because much of medicine is now based on technology, instrumentation and manpower, all of which are very expensive (1). The equitable and just distribution of limited medical resources has become increasingly difficult, because while in situations of poor health standards a small investment can produce significant benefits, in situations of high health standards large investments may produce little benefit. The ethical and practical issues related to allocation of scarce resources have multiplied significantly because of the achievements of modern medicine: