An impoverished 69-year-old man is diagnosed with cancer of the pancreas. There is no hope for cure, but radiation and chemotherapy, which could cost more than $150,000, may extend his life for a few months. If this patient unambiguously requests treatment, his doctors may struggle with the decision but will probably provide the treatment, ignoring the cost as a matter of principle.
On the other hand, a health department — or a hospital — proposes an action that would prevent many cases of some forms of pancreatic cancer. It could be offering free education on the effects of alcohol on the pancreas.
In both instances, health experts must make tough decisions that entail weighing the costs of an action against its benefits in extending human life. Why is the value of extending human life the determining factor in the first example and the cost of the intervention the determining factor in the second? These two scenarios expose tangled issues of ethics, cost, and cost-effectiveness and highlight a troubling structural bias against prevention.
Many people reject any attempt to put a dollar value on human life. From such a perspective, any withholding of potentially life-extending interventions on the basis of their costs is unethical. But within every organization and throughout society, limits on funding make it impossible to pay for every conceivable intervention. That reality forces health leaders to make painful decisions about what to pay for.
In your paper:
- Discuss this scenario in respect to ethics, cost and cost-effectiveness.
- What should a physician do in this case?
- If the treatment is refused, how would you go about finding a way to obtain treatment for this man?
Length: Submit a 3-page paper.
Expert Solution Preview
The scenario presented raises important ethical dilemmas that healthcare providers often face. These dilemmas arise when the costs associated with a medical intervention for a patient’s ailment or preventative measures for the general population are weighed against the benefits. In both instances, healthcare providers must make a difficult decision, keeping in mind the Hippocratic Oath of “first, do no harm” and their fiduciary responsibility towards their patients.
1. Discuss this scenario in respect to ethics, cost, and cost-effectiveness.
In cases where a patient is diagnosed with an incurable ailment, healthcare providers must weigh the benefits of interventions, both in terms of extending the patient’s life and their quality of life, against the costs associated with the intervention. In this case, the doctors must evaluate if the extension of the patient’s life by a few months is worth the cost of $150,000. This ethical debate is accentuated when healthcare providers endeavor to extend human life without regard to the patient’s quality of life or the financial implications for the patient.
While the first scenario involves the treatment of an individual patient, the second scenario is about preventing the onset of a disease in multiple individuals. The healthcare providers must evaluate if an investment in preventative measures, such as offering free education on the effects of alcohol on the pancreas, would be more beneficial than the treatment of an individual. An investment in preventative measures is often seen to be cost-effective in the long run, with significantly reduced costs later, as individuals are able to avoid the disease altogether.
2. What should a physician do in this case?
The physician must prioritize the best interest of the patient while keeping in mind the cost-benefit analysis of the intervention. In this case, they must have a transparent conversation with the patient about the costs of the intervention versus its benefits. The physician should also inform the patient about alternative treatments that may be more cost-effective and inquire if the patient has any financial constraints. Physicians must keep in mind that they have a fiduciary responsibility to their patients to provide the best possible care, but the implementation of this responsibility may be limited owing to the financial constraints that exist within the healthcare system.
3. If the treatment is refused, how would you go about finding a way to obtain treatment for this man?
If the patient refuses treatment, the physician must respect their decision, but they must also inform the patient that they are willing to explore other treatment options that might be more cost-effective. The physician should discuss the patient’s medical history, if any, and determine if they qualify for any clinical trials or research studies. The physician should also attempt to verify if there are any financial resources available to the patient, such as community or government programs that may cover a portion of the treatment cost. If all else fails, the physician should provide the patient with a referral to a financial counselor who can provide advice on how to pay for medical treatment.
As healthcare providers, our foremost responsibility is to provide the best care possible to our patients. While cost and cost-effectiveness should not be the sole factors in treatment decisions, they should be considered as contributing factors. In the cases where the cost of medical intervention is too high for an individual patient, healthcare providers must seek alternative treatments and financial resources that may be available. In the long term, preventative measures, such as increased education on ongoing health risks, may be more cost-effective than the treatment of patients after they fall ill.
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