They are terribly far from the people
The ideas of ethics specialists are far from reality
Julia Korowski, XX2 CENTURY, based on the materials of ETH Zurich Zukunftsblog: A litmus test of fairness
Ethicists disagree with doctors and ordinary people – this is the conclusion reached by scientists from the Swiss Higher Technical School of Zurich (German Eidgenössische Technische Hochschule Zürich) and the University of Zurich (German Universität Zürich). The results of the study are published in the journal PLOS One (Krütli et al., How to Fairly Allocate Scarce Medical Resources: Ethical Reasoning under Scrutiny by Health Professionals and Lay People).
Donor organs are a very limited resource. In 2014, more than 4,636 Russians were waiting for a new kidney, while, according to some estimates, every tenth patient does not live up to a planned liver or heart transplant operation. The shortage of vital medical resources inevitably raises the question: how to distribute them fairly? Ethicists have developed several criteria that help doctors make a decision. You can give preference to severe patients (the principle of "first – the sickest"), those who have sought help before (waiting list), those who will benefit most from therapy (prognosis), cure the youngest, arrange a "lottery" or use a combination of three criteria: age, prognosis and random selection.
However, ethicists, doctors and ordinary people understand justice in different ways. The researchers decided to find out what doctors and laymen think about the principles of resource allocation and how high moral standards are close to reality.
Scientists have prepared an online questionnaire that included 9 criteria for the distribution of scarce medical resources. Respondents were asked to consider several situations: organ donation, hospital bed allocation during an epidemic, and hip replacement designed to improve the patient's quality of life. In relation to each of them, the study participants had to evaluate the validity of each criterion on a scale from 1 to 7. 1,267 people took part in the survey: non-professionals, general practitioners, medical students and other health workers.
In all the situations described, the townsfolk considered the principle of "the sickest first" to be the fairest. The waiting list came in second place, the forecast came in third. Doctors looked at the problem completely differently. When distributing donor organs, they put the prognosis first, then the severity of the disease and finally a combination of three criteria: age, prognosis and the lottery principle. Unlike ordinary people, doctors believed that the patient's age was more important than the position on the waiting list – the latter took only the fifth place in the list of priorities.
"It was surprising to find out that non–professionals consider age an unfair criterion for organ transplantation, although when it comes to such operations, both doctors and ethicists consider it reasonable to give preference to young people," says Pius Krütli, one of the authors of the study. Such "age discrimination" was considered unfair by the townsfolk.
When distributing hospital beds during the epidemic, general practitioners considered the patient's prognosis to be the most important. In second place was the treatment of severe patients, in third place was a combination of criteria. When replacing the hip joint, the doctors agreed with the townsfolk and recognized the principle of "the sickest first" as the fairest. All respondents considered the principle of "mutual benefit" – the preferences of patients who used to serve society – unfair, the same applied to the patient's willingness to pay. The assessments of medical students often coincided with the opinion of practicing doctors, but the rest of the health workers often agreed with the townsfolk.
The scientists compared the information obtained with research data in which ethicists considered the fair distribution of resources. It turned out that the opinion of the "ethicists" is markedly different from the point of view of the respondents. They rejected the waiting list and the principle of "first – the sickest" – criteria that seemed to ordinary people the best. Some experts considered the lottery fair, which neither doctors nor ordinary people agreed with.
"The results of our survey showed that in some positions the point of view of ordinary people and doctors is diametrically opposed to the opinion of many ethics experts," says Krutli. The difference in what ordinary people and "ethics" think about justice is not surprising in itself: the latter believe that moral principles cannot be deduced from empirical data. "On the other hand, ethicists cannot simply ignore these results, otherwise the gap between moral standards and reality will widen, and, eventually, ethical arguments will begin to be discounted as far from life," he says. "Therefore, responsible persons should think about giving equal importance to the opinion of ethics specialists, healthcare workers and the general public when developing collective norms," the scientist summarizes.
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20.09.2016