Medical Ethics PHIL 148 @ Binghamton University, Sum 11


It is Immoral

It is immoral for hospitals or the government to limit resources on a first come first serve basis. By treating citizens in need on a first come first serve basis, the government or the hospital is disregarding their moral responsibility as structures for care in the eyes of many ethical perspectives. I believe resources should be used based on severity of the injury, illness, or situation. For instance it is fair to say that a person dying from gunshot wound is more severe than a laceration on someone’s leg. Both procedures require sutures and anesthesia. These resources should be used to sustain a life, over a leg and many ethical thinkers would agree.

Egalitarians would also disagree that treating patients on a first come, first serve basis would be just because this system of equality of treatment based on time denies certain patients a bare minimum of care. We can define the bare minimum of care for a gunshot wound victim to be; care to close up the wound. If we were following the unjust system and there are no more sutures left to close the wound then this system denies the patient of the bare minimum. In fact it is possible that care of any sort can be denied, if the resources are unavailable, to patients and therefore it is unjust. If we based the system solely on severity the bare minimum care could be met easily. Wounds that are in dyer need of stitches would get them and those that would be able to heal with a band-aid or bandage wouldn’t use stitches. Secondly, Egalitarians would find this system of treatment immoral because it is excluding and unfair to a portion of people. Egalitarians find that moral acts are ones done that keep the treatment equal for all. If only the first few people can be treated because they limit the resources for them solely, than the people who come into the hospital later cannot receive any treatment.  Egalitarians would agree that severity would be the best way to use resources because treatment for the injury would be based on a scale that treated everyone the same for the same severity of injury. For instance somebody with a gunshot wound at 9 am would receive the same treatment as some one who came into the hospital at 9 pm. If these two patients had been treated based on a first come first serve basis it is possible that the second victim would receive improper/or no treatment because all of the resources had been used up prior by lower level severity cases and therefore those two victims would not be treated equally even though they should be because they have the same injury. If they were treated on the terms of severity it is highly likely that the second injured patient would be able to receive the same proper medical care. Using severity to spread the resources equally proportional to the level of severity, just like it is known that taxing on a proportional scale would satisfy an egalitarian. One is treated the same as the other in proportion.  By treating patients based on severity level you are standardizing a basic minimum as well. You are saying that the lowest level severity patients will use the least amount of resources, which gives the bare minimum, and then scale the amount of resources to be used accordingly. This provides equality throughout the levels of severity and throughout the system. For instance, the gun shot wound patient at 9 pm would receive the same treatment as someone at 9 am using the same resources, including patient care, and doctoral attention. Someone who fell off of their bicycle would receive the same amount of attention but on smaller scale, 3 doctors do not need to diagnose how to fix a simple laceration on someone’s leg, but 3 doctors may need to figure out how to remove the bullet, close the incision, and the fastest safest way to go about it. So it’s all equally relative to the problem.

Utilitarians would also find it immoral to serve patients on a first come first serve basis. Utilitarians wish to maximize overall utility for the largest amount of people, therefore they would find this system immoral because it would not be satisfying this point. First, this system would not provide care for those who would need it after a certain time because the resources would be used before they could be applied to the later patients. Therefore these patients would not find happiness or satisfaction, or relief from pain. If the gunshot wound victim comes in at 9 pm and cannot receive treatment because there are no resources to treat him, he will be in severe pain and possibly handicapping his future. In a utilitarian view, the act of not providing care to this patient is immoral. Providing at least the minimal amount of care to anyone in need is seen as more justifiable than treating a few patients thoroughly. For instance, providing the gunshot wound victim with no care because he was admitted to late and the resources have all been used up is immoral. The resources should have been saved to treat such severe cases and spared on the cases that unnecessarily use the resources. For a utilitarian we can maximize resources this way as well. Providing the resources to patients in an organized manner based on severity would allow necessary resources to only be used in such cases in which they are desperately needed. For example using a bandage on a cut instead of stitches, we are able to save the stitches for someone with a gunshot wound, this maximizes utility of the resources. Also, the doctors are unable to provide the care for the patients who come later and are therefore unsatisfied. These doctors wish to fulfill their Hippocratic oath to do whatever they can to treat as many people as they can. By distributing the resources by severity you are allowing more patients to be served and more doctors feeling fulfilled. If we measure utility in satisfaction, then the first come first serve system is immoral because it creates more dissatisfaction than satisfaction.

The system first come first serve would be an unjust, immoral system. It would lead to more deaths, dissatisfaction and unhappiness. Patients in need of life-sustaining treatment would be unable to receive it because of limited resources.  Patients and doctors would be dissatisfied with their level of treatment for patients that come when resources have run out.  Unhappiness would plague the system because everyday more and more unhappy people would remain that way without being treated properly. Utilitarians and Egalitarians agree that a basic minimum to provide resources must be provided for the system to be morally right and if it were based on time this minimum could not be provided for all in need. Therefore, severity is seen as the fairest way to organize and distribute resources because it creates this minimum for everyone.



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