Table 1 Topics related to resource issues treated in seminars (S), individual patient case discussions (I), and principled/general case discussions (P)
From: Roles and responsibilities of clinical ethics committees in priority setting
Topics | Examples |
|---|---|
Introduction of new costly drugs | New, costly drug for cystic fibrosis (P); co-payment for expensive drugs (I + P) |
Extraordinarily costly established/existing treatment | Costly treatment for patient with rare condition (I); home ventilator treatment (I); costly drug for serious and rare psychiatric disease (I); requirements for patient conduct and compliance when treatment is particularly expensive (I) |
Application of priority criteria | Age limits for lung transplantation (P); triage in the emergency department (P); Caesarean section “on demand” (S); priority setting in rehabilitation medicine (S); discussion of national priority setting criteria (S) |
Resource use for potentially vulnerable groups | Illegal immigrant with serious chronic disease and repeated admissions (I); repeated cardiac surgery for substance abusers (P); priority setting when medical evidence is scarce (P) |
Budget/resource constraints compromising good practice | The incompatible logics of “care” and “production” (S); reductions in staff and number of beds leading to poorer services (P); transfer of imminently dying patients to nursing homes (P); early discharge from hospital due to resources constraints (I) |
Futility of care | Expensive life-prolonging treatment with questionable benefits (I); priority setting in intensive care (S) |