Rationing expensive lifesaving medical treatments.

Abstract

In the last fifteen years, medical technology has made significant and spectacular advances. Hemodialysis, coronary artery bypass graft surgery, CT scanners, and organ transplants are among the treatments now available to patients. In recent months, in fact, the media has reported the increased use of artificial hearts, heart transplants, and liver transplants. These technological advances, however, have been accompanied by troublesome legal and ethical issues. For example, someone must decide which patients will receive a medical resource when demand exceeds supply. Similarly, and more commonly, someone must decide whether the significant number of patients who cannot afford an available treatment should receive it despite the cost. In response to these troublesome issues, hospitals, doctors, and commentators have either proposed or implemented rationing systems based on criteria such as the social worth of the patient, likelihood of survival after the operation, and ability to pay. In this Article, Professor Mehlman examines the possible systems for rationing expensive lifesaving medical technologies. First, he concludes that the costs of any rationing system probably exceed its benefits. Consequently, he rejects the rationing of expensive but available lifesaving medical technologies. Second, he argues that the increased availability of the technologies and the recent expansion of patient rights to sue will result in a substantial number of judicial challenges to rationing. Finally, he suggests detailed criteria to aid the courts in deciding whether a resource has been improperly rationed.