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Archived Comments for: Ethical challenges related to elder care. High level decision-makers' experiences

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  1. The Feelings of High Level Decision Makers is Irrelevant to the Allocation of Resources in Healthcare

    Tom Shillock, M2 Consulting

    18 June 2007

    Why do the authors assume that their survey was needed to illuminate the feelings of high-level decision-makers (HDMs) in allocating scarce healthcare resources? Or that the feelings of the HDMs could shed light on how to allocate scarce resources for healthcare in the face of aging populations?

    Everyone knows that resources for healthcare are finite and that distributions are largely iniquitous. Deciding the morally best or even better way to allocate those resources is necessarily an ethical endeavor. But the authors’ survey and discussion of the HDMs job feelings about such decisions does not reveal a moral psychology different from that of any other human being, it would be quite surprising and suspect if it did.

    HDMs who felt that budgetary constraints precluded them from acting in the best interest of the elderly could have resolved their “ethical dilemmas” and the pangs of conscience by resigning. That option is much easier for them than for a nurse. How many, if any, of the HDMs did this the authors do not say yet that would be a metric of how keenly they felt that their job required them to make morally unacceptable decisions. Short of that, they could assuage their consciences by speaking out or advocating for more resources or better policies. They have options that ameliorate the “meaning” (as the authors call it) of job-related conflicts and unpleasantness, ethical or otherwise. Yet employing HDMs that acquiesce in the problem (“If I don’t do this job someone else will.”) institutionalizes a moral stance that impedes reform.

    Note that most of the feelings attributed to HDMs may arise from an inability to derive complete satisfaction from a job well performed either because of the inherent conflicts and tradeoffs or attendant criticism. Or, as the authors allow, HDMs may view their self-interest in conflict with their ex officio obligations. Neither conflict is necessarily ethical.

    Competing interests