The Ethical Approach To Limited Resources

Can’t get a desperately needed lab test? Not enough healthcare staff? Running out of patient beds? Worried a respirator might not be available? As you work without adequate protective equipment, are you thinking that you’re putting your life at risk taking care of your patients?

Overwhelming need and limited resources. Sounds like life as a medical missionary, but third world realities may come to the United States with COVID-19. Let me share some practical ethical guidelines I’ve taught to more than 500 new healthcare missionaries while I pray that you don’t have to apply them.

Allocating limited resources raises the ethical issue of justice—how do you treat patients fairly?

First, you always want to be as impartial as the situation allows.

Second, do the best you can for the most people with the resources you have.

Third, without enough time, personnel, supplies or equipment, at some point you will be forced to decide who gets and doesn’t get your limited resource. Let me give you a real life example.

When I arrived on the mission field, our 135-bed hospital only had electricity 11 hours each day, because the price of fuel for our big generator consumed 25 percent of the hospital’s budget. At night we ran a small generator that could power one isolette and allow us to turn on the operating room lights. We had a high incidence of multiple gestations, one in 28 births, and we had lots of premature babies.

You can put three preemies in one incubator, but what do you do when a fourth is born and there is no place for the baby? You hope one infant is doing well enough to be replaced, but if not, you take the one who has little chance of survival out and give it comfort care.

This is an extreme example, but it makes my point. You are forced into using a utilitarian ethic decision-making process under these conditions:

• There are limited resources.
• There are no moral absolutes for or against an action. (You don’t give the baby with the poor prognosis a lethal injection. You still want this child to survive.)
• You know your moral duty but are not sure how to fulfill it. (Save lives. Heal the sick.)
• There is a conflict between two moral duties and both cannot be fulfilled. (I can’t save all four babies).
• You must prioritize duties. (If I put the latest preemie in the isolette it will probably make it. The one I removed is likely to die whether it is in the isolette or not.)

When you are forced to employ a utilitarian ethic, you
constantly reevaluate your allocation decisions based on changing circumstances. If the last baby put in the isolette is going downhill the next morning and the baby with comfort care is improving, I would reverse my decision.

When you have limited resources, you can never be satisfied with that status. You have the moral obligation to be constantly working
to get the resources you need so you won’t have to make a utilitarian decision, because you now have enough personnel, equipment and supplies. We solved the electricity problem by building a hydroelectric project on the 42-foot high waterfall below the hospital and got 24-hour cheap electricity. A large NICU followed at the hospital.

These type of allocation dilemmas can be heartbreaking. If possible, seek a second opinion from your colleagues as you make your decision. Then explain your reasoning for what you are doing to other staff involved. When available, seek a clear policy from your ethics committee to guide you and all staff for the situations you are facing.

Most of all, ask God for wisdom, insight, courage, and peace as you navigate through the storm. He understands. He has been there.

Download full ebook "A Healthcare Worker's Response to COVID-19" here