Question

Drawing on your own moral beliefs and values, respond to the following:
How much is it worth to keep an 86-year-old woman alive in a vegetative state? A 10-year-old? Your grandmother?
What criteria should be used to determine who gets medical resources that are limited? A lottery? the ability to pay? Merit?

Answer 1

In a vegetative state, the person will be unconscious and the awareness of themselves or their environment is lacking. Unlike coma in ‘vegetative state’ at some point, the person’s eyes will be open and times when they seem to be ‘awake’. Involuntary movements are possible like grinding their teeth, thrashing, and facial movements such as grimacing, yawning or smiling. Some responses to stimuli may be present. When the chances of recovering from the consciousness are very low, it is said to be in a “permanent” vegetative state.

Keeping the person in a vegetative state alive requires good basic care such as frequent position changes, a feeding tube, intermittent antibiotics for infections and some ongoing mechanical ventilation support.

In the case of old age, people keeping them in the vegetative state may not result in a positive outcome. The individual or family preferences must be considered in making decisions. The treatment should only be given if it is in the best interests of the patient. The horrifying feeling of allowing their relative to “starve and dehydrate” to death may hinder some families from withdrawing the tube feeding.

The advanced directives play a role here. If the patient had made an advanced directive or living will, that must be considered while taking a decision. Considering the resources used to manage old age people in the vegetative state proper guidelines must be developed by the federal government regarding this, by preserving the best interest of the family.

In the case of young patients, the recovery chances are more, especially when the vegetative state is a result of single organ damage. The chance of recovery is based on the severity of the brain injury. If the brain injury is minimal the recovery chances are more. Many young people (around 50%) in a vegetative state one month after traumatic brain injury eventually recover consciousness. The young people must be kept under proper care at least to a considerable period of time allowing the possible recovery.

The cultural and religious beliefs also must be considered while taking medical care decisions.

The distribution of life-saving scare resources must be done based on the strategies. In many countries, the allocation of limited resources is done by explicit rationing. The patient selection criteria must be based on personal and social values, not on the basis of ability to pay. The inequitable distribution of healthcare resources will cause injustice.

IN the American healthcare system, the allocation of organs for transplantation and the allocation of beds in intensive care units are the main explicit rationing forms and it involves the most apparent patient selection criteria.

The biases like gender, economic status, caste etc. must be minimized while distribution the scare resources. The patient selection decisions for the limited availability of treatment or services must be made by a council, consisting primarily of physicians and other health care personnel from the relevant hospital or community.

When demand for healthcare resources exceeds the supply, resources must be distributed on criteria.

Macroallocation: the distribution of healthcare at a broad institutional or societal level. like primary and preventive care.

Microallocation: focuses on treatment decisions regarding particular persons within the limited time. The healthcare personnel employ various medical criteria in order to make such decisions. It mainly takes place in institutional and societal contexts of limited resources.

The use of triage system is the best method than the lottery method and payability to avoid the wastage of resources and ensure equality.

The micro-allocation has a wide range of criteria for determining which patients receive available resources.

1. Social criteria: Consider the social value, the progress of science, favoured group, resources required, and vital responsibilities.

2. Sociomedical criteria. The micro-allocation must be considered based on age, psychological ability, and supportive environment.

3. Medical criteria: involves the health-related outcomes of treatment like the medical benefit, imminent death, the likelihood of benefit, length of benefit, and quality of benefit.

4. Personal criteria: the personal factors like willingness, responsibility, ability to pay, and impartial selection also play a role in developing the misallocation criteria.

The approaches for microallocation are:

1. Productivity

2. Impartiality

3. Settings