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The Rationing of Health Care for Those Whose Prognosis is guarded

This research project sets out to investigate on a very fundamental area of health care which actually puts medical practitioners at risk, or rather, in a dilemma when faced with the challenge of making a decision on a patient. It also puts insurers to test when they limit the funds to be availed to effect treatment of a patient. It starts by creating an understanding of the various concepts involved within this analysis and then proceeds to determining the various reasons for and against rationing of healthcare for those whose prognosis is guarded. In the end it is very difficult to ascertain the proper action to take but as we shall notice one has to make an own stand because in either cases there exists a moral dilemma. To take one side implies sacrificing the other.


This research paper presents an ethical dilemma in the area healthcare – rationing healthcare for those whose prognosis is guarded. The question of ethics has been one of the disturbing issues affecting most doctors in the world especially with regard to their decision making process. This is simply because the decisions they are expected to make concerning their prognosis or their patients in general have a very significant effect on their patients. And thus they need to be very reasonable in making various decisions. This research project sets out to analyze the ethical dilemma issues and in the process give my personal stand on the same. But before that I will need to define the various terms as used in the research and the medical realm.

Rationing of Health care for those whose prognosis is guarded

Healthcare rationing can be defined in various ways; either economically, or regulatory. Economically, healthcare rationing designates restricting health care goods and services to only those who can afford to pay. A regulatory definition shows healthcare rationing as an aspect of limiting health care goods and services from even those who can afford to pay.

Guarded Prognosis is my second term to define; it is composed of two words – guard, and prognosis. Prognosis as a medical term that refers to a doctor’s prediction of how a patient’s disease will progress, and whether there is a chance of repossession. Guarded refers to a patient and his removal of knowledge something like the prognosis. Therefore prognosis is a prediction of the probable course and outcome of a disease.

By combining the two terms a new concept emerges; guarded prognosis. Guarded prognosis refers to a situation when the doctor makes, evaluates a forgiving but then keep the findings from him or her. A good example of guarded prognosis occurs when a patient is terminally ill but the doctor realizes that telling this patient about the impending situation will aggravate matters and even cause depression.

Therefore, having defined the topic concepts separately, it is important to combine them and come up with a clear meaning of the statement “rationing of healthcare for those whose prognosis is guarded.” This is an ethical issue of concern to both the nursing and healthcare professionals. It is of concern because a decision has to be made no matte what, and in a timely manner. Therefore, to ration healthcare for those whose prognosis is guarded implies that a medical practitioner has already evaluated the patient, and made a prediction concerning the patient’s disease progress, but out of consideration for the patient’s expected outcome on realizing the bone of contention, the medical practitioner decides to ration treatment.

How Does Healthcare Rationing work?

Healthcare Rationing creates a different perspective in a great deal of people who consider that treatment as a right that is available to all no matter the costs, no matter the chances that the outcome will actually be positive. This because in spite of this perspective people realize out of disappointment that cash has to be dished out in order to obtain treatment. Further still people remember that funds are scarce resources, thus limited. This logically implies that opinions concerning treatment too, are limited. This phenomenon is rightfully presented by Peter Singer (July 2009) as he continues to assert that “health care is a scarce resource, and all scarce resources are rationed in one way or another.” But how does one know that by rationing he/she has made a right decision or not? Could rationing be a subjective issue or an objective one? In fact this is the major dilemma now because of the fact that we need to have it in our minds a framework for evaluating rationing. Thus David Leonhardt (June 2009) by affirming the fact of rationing as an economic realm, continues to explain that, “the choice isn’t between rationing and not rationing. It is between rationing well and rationing badly. Given that the United States devotes far more of its economy to health care than other rich countries, and gets worse results by many measures, it’s hard to argue that we are now rationing very rationally.” Therefore, rationing is something that should be made intellectually. Leonhardt gives a USA scenario by listing three primary ways it uses to ration health care. In the first scenario, the government increases healthcare premiums, thus reducing worker pay. This results in “tradeoffs between healthcare services and other consumption.” The second scenario involves high premiums implying smaller companies won’t afford health insurance for their workers. The third scenario is that one of the government failing to provide certain types of care.

Types of Rationing

Rationing exists in different ways, with the first one being; insurance coverage exclusion or pricing. This type of rationing implies that one will receive or be denied coverage depending on the existing medical conditions. However, if the patient insists on receiving treatment then he will be required to pay higher premiums. This condition limits one’s ability to receive cover.

Another rationing is that done by pharmaceutical companies where by the manufactures make rationing available based on one being able to pay or not; thus by increasing the cost of Medicare or Medicaid acts as a rationing factor as only those able to pay can afford treatment.

There is also rationing through government control which occurs when the government makes reforms that signify rationing. This type of rationing can be observed in three ways: one is, through “an expanded federal bureaucracy, the pending insolvency of Medicare within a decade, and the fact that 25% of Medicare costs are incurred in the final year of life.” (Newt, 2009, August 16)

Another type of rationing is the physical decision rationing, or what is rather called ‘optimum outcome-based rationing in which the judgment of attending physicians on whom is the most likely to benefit from a specific treatment is another form of healthcare rationing, example being the selection of stroke and head injury patients for rehabilitation, and this, in the case of USA, is based on the judgment of the attending physician.

Rationing based on economic value added which involves the application of the concept called “quality-adjusted life year”. Under this type an analysis is made as pertains the cost-benefit of applying a particular medical procedure. We are being told that “it reflects the quality of life added due to incurring a particular medical expense.”(Singer, July 2009)

Arguments for Rationing Process of Healthcare Services

In order to provide an analysis of the arguments for rationing process of healthcare I will I will give the following reasons for rationing as I proceed to synthesis of the same.

Rationing can be looked at as a fiscal discipline. This type of rationing is actually promoted by a former Republican Secretary of Commerce in the US Peter G. Peterson (July 2009) who re-iterated that at times rationing is inevitable and desirable considering the state of USA. These rationing provides that in cases where the quality of life can not be improved and in which case therefore a lot of funds are going to be liabilities to the state then an individual be denied cover. Therefore, there should be an establishment of a budget that deals with government healthcare expenses, by establishing “spending caps and pay-as-you-go rules that require tax increases for any incremental spending. A government in my opinion has a role of utilizing the revenue it receives from tax. Hence the need to ration healthcare whenever a situation shows that even though medical cover is provided ones’ life is not going to improve so that such a person can produce revenue to the state. (Peterson, July 2009)

Another reason for rationing healthcare relates to the old-age-based health care rationing. This reason begun to take center stage in America in 1983 with an economist Alan Greenspan wondering “whether it is worth it” referring to the use of 30% of the Medicare budget on 5 to 6% of those eligible who then die within a year of receiving treatment. This matter was actually re-affirmed by Richard Lamm when saying that the elderly “have a duty to die and get out of the way.”(Lamm, 1984)This conception was actually promoted by some personalities thus making death good in the height of age.

Sometimes life can be so painful and to top it all no foreseeable treatment can cure the patient. Any attempt to initiate treatment requires a great deal of funds and the coverage provided does not provide such funds. One approach should be to continue to attempt to restore this person’s health by using the available resources. But again resources are scarce that one can not simply continue exhausting them on one individual while his prognosis indicates minimal chances of survival.

Reasons against rationing

Ant –rationists base their arguments on a very fundamental principle that every human person has a right to live. And this is actually based on a moral appeal from one free, rational individual to another; this appeal lays claim to the means necessary for me to fulfill my moral function s a person, and seeks the other to respect that claim. To actually speak of the violation of rights, we must make a clear distinction between the right and the thing to which the person has a right. A right itself is physically violable, but not morally: that I, you may imprison me, or kill me, or deprive me of my possessions, but this does not mean that you have taken away my rights to life, freedom, or property. Thus, in support of opponents of rationing of healthcare consider violation of a right a grave moral evil. It is actually true that human being exists on earth for a purpose which implies that there is that ability to fulfill our end on earth, and this requires life, work, freedom – without which we cannot achieve our fundamental goals. As much as we have rights of these things, we also have a duty to respect the rights of others to them. To say an individual should make a decision to withhold information from a patient in order to avoid provision of treatment by merely assuming that the guarantee of treatment will be in vain is actually bad on the basis of an individual having a right to decide the possible course of action in his life. Sometimes we should inquire as per how sure is the one deciding that the alternative action couldn’t result fruitful.

Another argument as provided above relates to the fact that rationing is part of a fiscal discipline. This is actually a grave moral evil in my opinion; to equate human life with a mere fiscal opinion which is actually an outcome of speculation. It cannot be used to reduce the value of life to a level that it equates with fiscal policies.


In conclusion I am confident to state that rationing of health care is a very significant area for medical practitioners to address. It touches on a very fundamental principle of ethics which is very vital in their profession. Taking any stand implies sacrificing the other. We realized that resources are scarce therefore again a dilemma needed to be solved in which case denial of consideration is presented which again is a sacrifice. In all I can say that it is left at the disposal of whoever executing a decision to make proper judgment basing on the status quo of the patient.

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